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Martha Jefferson Medical Enterprises
Practice Management
 
 
 
 
 
 

spacerWelcome to Martha Jefferson Medical Group. For your convenience and to expedite your registration process, please download and print the new registration forms here

  
  FIRST VISIT FORMS  
  adobe Registration Form and Financial Policy Please complete the demographic form and insurance information.  
  adobe Adult History Form Please complete the self-history form and bring it to your first visit along with a list of your medications.  
  adobe Pediatric Registration Forms Parents/Guardians—Please complete all forms and bring them with you to your child’s first visit along with insurance information and any current medications.  
  adobe Spanish Registration Forms Informacion del Paciente. Please complete this form along with the age-appropriate forms below.  
  adobe Spanish Pediatric Forms Forma de Historia de Salud Pediátrica.  
  adobe Spanish Adult History Form Historia Completa del Adulta de Salud.  
         
 

FOR PULMONOLOGY PATIENTS
Please download and print the registration forms for Martha Jefferson Medical Associates. The history forms detailing your past medical history, and in particular the Respiratory Questionnaire will be important information for your first visit with Dr. Schult. Please bring your medications with you to your first visit also.

  
  adobe Dr. Alexander Schult Packet  
  adobe Authorization for Release of Information  
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