MedStar Request Form

If not, please answer “no”
Confirmations will be sent to this email
Answers may include, Follow up, New patient Visit, Maternity, Pediatrics, etc.
Patients who are both Deaf and Blind require a specialized tactile interpreter and so we need to know this information in advance.
This is required for billing. If you do not know the Routing Code, please consult your MedStar Office Manager or Corporate Contact.