Gonzaga Family Health
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  • COVID-19 eCARE
  • TeleHealth
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  • New Patients
  • In The Community
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YOUR CART

Welcome New Patients!

Online and Downloadable Forms

Great! You've chosen to save time on your first visit, which means less waiting. Simply begin by selecting the button which best describes the form you need. If you would rather print out the form you need, just make the selection at the bottom of this page.

​If you have any trouble, just give us a call at 301-729-9475.


I'm an adult male patient filling this out for myself.

I'm an adult female filling this out for myself.

PEDIATRIC: I am a parent filling this out for my MALE child.

PEDIATRIC: I'm a parent filling this out for my FEMALE child.

Other Important Forms

Controlled Substance Policy
File Size: 312 kb
File Type: pdf
Download File

Office Financial Policy
File Size: 110 kb
File Type: pdf
Download File

General Adult Onboarding Form
File Size: 161 kb
File Type: pdf
Download File

Release of Protected Health Information
File Size: 139 kb
File Type: pdf
Download File

HIPAA Authorization Form
File Size: 96 kb
File Type: pdf
Download File

Supplemental form for Female Patients
File Size: 106 kb
File Type: pdf
Download File

Supplemental form for Pediatric Patients
File Size: 96 kb
File Type: pdf
Download File

Locations

957 National Highway
LaVale, MD 21502

4 S. Broadway
​Frostburg, MD 21532

Phone & Fax

Phone: 301-729-9475
Fax: 301-729-9474

Phone: 301-689-3138
Fax: 301-689-9561

Contact Us

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