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or call us directly at (410) 730-3399

New Patient Forms and Information

Once completed, bring forms with you to your appointment along with your picture ID and insurance card at least 15 minutes prior to your appointment time. You may also fax your forms to 443-698-8298 or email to: appointments@centennialmedical.com

Medical Record Release of Information Authorization to Centennial Medical Group

To request a release of medical record information to Centennial Medical Group, please fill out the following form:

Medical Record Release Form 

Patient Registration

To register as a new patient with Centennial Medical Group, please fill out the following form: 

Patient Registration Form in English

Patient Registration Form in Spanish

Patient Medical History

To fill out your patient medical history, please fill out one of the following forms: 

Patient Medical History Form in English

Patient Medical History Form in Spanish

Need to Book an Appointment?

You can email us directly: appointments@centennialmedical.com

Or call 410-730-3399

No need to book an appointment for urgent care. Walk-in to any FirstCall location: MAPLE LAWN-COLUMBIA CROSSING-ELLICOTT CITY-CLARKSVILLE-BURTONSVILLE