It is with pleasure that we welcome you to Capital Women’s Care. To help your visit go as smoothly as possible, please assist us by bringing the following with you:
- This form must be completed and signed before the day of your appointment. If not completed your appointment will need to be rescheduled.
- Current insurance card(s) and Drivers License or Photo ID must be presented upon arrival.
- Insurance referral form, if necessary.
- Co-payments are collected upon arrival. We accept cash, check, American Express, Visa, MasterCard, and Discover. If you are unable to make your payment, your appointment will need to be rescheduled.
- Please arrive 20 minutes before your scheduled appointment time to complete the necessary registration information.
- Missed Appointment Policy: We respectfully request that you cancel your scheduled appointment by phone 24 hours in advance. If you do not cancel by the deadline, you may be assessed a $50.00 missed appointment fee. This fee is not covered by insurance carriers and it will be your responsibility to pay. Our aim here is to open otherwise unused appointments for our patients, not to collect missed appointment fees. Your cooperation and consideration is appreciated.
- Capital Women’s Care is located in 9711 Medical Center Drive Suite 109, Rockville, MD 20850.
- We participate with many insurance companies. Please confirm the participation of our providers with your insurance company. If your insurance company requires a referral it is your responsibility to obtain the referral. The referral must be presented at the time of your appointment. This office cannot provide treatment if the required referral has not been obtained. If you do not have your insurance referral form at the time of your appointment we reserve the right to cancel and reschedule your appointment or you may pay in full at the time of service.
- Please notify our office if there are any changes to the following information: Home Address, Telephone Number(s), Insurance Information.
- The charge for the completion of forms is $20.00. Forms will be completed within two weeks.