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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 Annual Consent Form Annual consents, release of information, and assignment of insurance benefits.  
  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 Authorization for Release of Information

For new patients transferring their care to Martha Jefferson Medical Group, please complete the Release of Information form to have your records sent to your new provider. Sending this form to your former provider prior to your appointment with your new doctor will help us to receive your pertinent medical records in time for your appointment.

 
         
         
 

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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