Important Patient Information: Forms

  • There will be a charge for each form submitted. This fee must be paid in full (self-pay) in advance.

$15 = 1-4 pages
$30 = 5-9 pages
$45 = 10+ pages

  • We no longer accept faxed forms. All forms must be dropped off or mailed to us at:

General Internal Medicine
ATTN: Nurse Manager– Forms
3800 Reservoir Rd NW
PHC Building 6th Floor
Washington, DC 20007

  • If the patient has not had a physical within the last year, an appointment must be scheduled prior to our staff completing the form unless a shot record only is required.
  • Please indicate how you would like the form to be returned: picked up, faxed (must be directly to patient/guardian) or mailed (must provide a stamped, self-addressed envelope).
  • If you require a receipt for payment, all forms must be dropped off.
  • Please allow 10 business days for all forms and letters.