New Patients
At the Montgomery Family Practice we value your time and your privacy. We've provided copies of our new patient information forms for you to download, print, and complete at home. You may bring them into our office during your next visit. They will not be stored or sent online, but are offered here simply for your convenience. Montgomery Family Practice follows Federal HIPAA requirements for maintaining patient privacy and healthcare portability.
New Patient Information Form »
Insurance Plans
Montgomery Family Practice participates in the following plans. If you do not see your provider listed, or have a question about payment or insurance coverage, you may contact us at 301-570-7770.
- BCBS MD
- BCBSDC
- MAMSI
- MAMSI LIFE AND HEALT
- OPTIMUM CHOICE
- MDIPA
- UNITED
- UNITED AMERICHOICE
- MEDICARE
- MD MEDICAID
- AETNA
- PHCS
- Great West
Policies
Late Arrivals/Missed Appointments:
Please note that if you are more than ten (10) minutes late for your appointment, you may be asked to reschedule. Please be considerate and call our office as early as possible if you are unable to keep your scheduled appointment. Missed appointments will incur a charge of $25 ($75 if a procedure was scheduled) that will be due prior to your next appointment. Repeatedly missed appointments may result in your dismissal from the practice.
Insurance cards and drivers license:
We will ask for your insurance card and drivers license at the time of your visit. Your cards are scanned into our system and added to your electronic chart allowing for improved patient security and identification.
Co-Pay/Insurance:
If your contract agreement with your insurance carrier requires you to pay a co-pay, it must be collected prior to each office visit. If you are unable to pay your co-pay, you will be asked to reschedule. As a courtesy, we will only submit a claim to your primary and secondary insurance. If you have a tertiary insurance, you are responsible for submitting to them.
Letters/Forms:
There will be a charge of $10.00 for any requested letter written by the physician. There will be a charge of $20.00 and up for completion of forms – school physicals, DMV, CDL, etc. depending upon the amount of time it will take to complete all forms. Please allow up to 7 days for completion of forms.
Patients who require Payment Plans:
Patients must qualify. In order to qualify, you will need the following if they apply:
- The total number in your household.
- A copy of the most recent tax return with W2’s
- A copy of two (2) recent check stubs of every income in the household.
- Social security, child support, or disability if you or anyone in your household is receiving it.
- Verification from your employer on company stationary stating that they do not provide health benefits.
Payment Plans for Self-Pay Patients:
Payment is due at the time of service. If a payment plan is required, a signed agreement must be made at the time of service with the first payment due on the day of service. Balances under $500.00 must be paid in two (2) payments. Balances above $500.00 may be paid as determined by the Office Manager.
For more information about Montgomery Family Practice and our services you may contact us at 301-570-7770.
Montgomery Family Practice
18111 Prince Philip Drive
Suite T-12
Olney, MD 20832
Voice 301-570-7770
Fax 301-774-7724
Hours:
Monday - Thursday
8:00 am until 6:00 pm
Closed Fridays
Closed 12:30 - 1:30 p.m. for lunch
Links & Resources
General Medical Info
Family Doctor.org »
Medline Plus »
Agency for Healthcare
Research and Quality »
Centers for Disease Control »
Prescription Assistance
Partnership for
Prescription Assistance »
Cardiovascular Health
American Heart Association »
Heart Healthy Recipes
AHA Delicious Decisions »
Teens and Drugs
Parents - the Anti-Drug »
Kids and Handwashing
Henry the Hand »
Genetics
The NIH Genetics
Home Reference »