Patient Forms

For your convenience, we have provided the following forms. Please print, fill out, and bring all necessary forms to our office at your next appointment. If you are not sure which forms you need to bring, please feel free to contact our office.

Patient Registration Form
Maryland Heart HIPPA
Financial Policy
Patient History Form
Vein Screening Form


Need to get a copy of your medical records? You can request that here. There are a few convenient ways to request your medical records by mail or fax.
Print a copy of our Medical Records Request Authorization Form. Please fill out the form completely, and mail the completed Authorization Request Form to:

Maryland Heart Associates
Medical Records Department
1401 Madison Park Drive
Glen Burnie, MD 21061

Or fax the completed authorization form to (410) 766-8677. For additional information, call our Medical Records Department at (410) 761-8007.
Pertinent information from your medical record is sent free of charge when requested for follow-up care. Copies of records or pertinent information requested for other reasons are subject to processing and per-page fee.
To download a copy of the Medical Records Release Authorization Form, click here. You will need Adobe Acrobat Reader to view and print this form. Adobe Acrobat Reader is a free plug-in for web browsers. It is available for most major computer platforms.
Maryland Heart Associates understands that your health information is personal. We are committed to protecting your medical information. Our policy is to provide access only to people with the need to know your medical and billing information to perform their job.


Need to renew a prescription? You can do it by calling (410) 761-8007. Assuming the request is authorized by insurance and approved by the doctor, we will send the information to you or your pharmacy within two business days.

Depending on your preference, your refill will be called into your pharmacy or mailed to your primary (home) address.

To assure your prescriptions are filled in plenty of time, we would prefer at least a week's notice before your prescription runs out.