Due to the inclement weather conditions, some of our offices may be closed for in person visits or operating with reduced hours on 1/20. However, we want to ensure your care continues uninterrupted—many of our locations are offering telehealth visits as an alternative. Please be aware that our Jefferson office is closed. Please contact your office for specific details and availability. Stay safe and take care! Be sure to check out our Facebook page for more updates!

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Patient Forms

  1. Notice of Privacy Practices (PDF) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
  2. Authorization for Release of Medical Information (PDF) – Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
  3. Authorization and Consent for Treatment (PDF) – All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
  4. Preferred Contacts (PDF) – Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
  5. Financial Policy (PDF) – This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
  6. Language Services
  7. Minor Consent Form (PDF)

Our Locations

After Hours Clinic
45 Thomas Johnson Drive
56 Thomas Johnson Drive
63 Thomas Johnson Drive
Ballenger Creek
Behavioral Health
Brunswick
Jefferson
New Market
Physical Therapy Ballenger
Physical Therapy Walkersville
Urbana
Walkersville
Woodsboro