Patient Forms


Our Doctor’s Specialties:

Family Medicine
Geriatrics
Internal Medicine
Pain Specialist
Podiatry
Psychiatry
Ophthalmology



Our Partnerships
Our Partnerships


The following describes how your medical information may be used, disclosed, and accessed. In accordance with the Health Insurance Portability Accountability Act of 1996 (HIPAA), MD24HouseCall Physicians will keep all of your health information confidential.

Note that for the purposes of medical treatment (e.g. mediating prescriptions, discussing your case with a consulting physician), payment (e.g. insurance paperwork which shows your diagnosis and corresponding diagnostic codes), health care operations (e.g. self-auditing our medical records, quality improvement), and medico-legal considerations (e.g. medical examiners, law enforcement officials, public health authorities), your health information may be released, obtained and/or disclosed by telephone, email, mail, or fax.

New Patient Agreement:

MD24HouseCall is pleased to provide acute medical care, primary care, consultations and/or concierge care. Please note that the one-time house call, office visit, electronic mail or telephone consultation fee includes:
◦A physician consultation and any necessary diagnostic testing available at the time of the consultation (e.g. any diagnostic tests and equipment stocked by MD24HouseCall) along with medical or surgical treatment at the time of the consultation including injections, dispensed medications, and prescriptions for medications.
◦Prescriptions for any future diagnostic testing you or MD24HouseCall feels you need to confirm or monitor your diagnosis. Testing shall be followed-up by you & your family physician or by MD24House Call Physicians if you opt for future care with MD24HouseCall.
◦Twenty-four hours continuity of care during which any medical, surgical, or pharmaceutical questions, concerns, or adverse reactions will be addressed. Any medical issues arising 24 hours after the house call or office visit requiring physician re-evaluation for physical exam, repeat lab or diagnostic testing, or prescription medication shall be addressed to your family physician or by MD24HouseCall if you opt to pay MD24HouseCall for another consultation. If you’ve had a telephone or email consultation, you have up to 2 days to follow-up for an office visit related to the initial medical concern(s) at no additional cost; thereafter, you will be charged MD24 House Call Physicians' standard fees for any office visit or house call, be it for the same initial medical issue or a new medical issue.
◦An invoice that you shall be responsible for submitting to any third party health insurance companies for reimbursement (If you are a patient with insurance other than Medicare, note that MD24HouseCall does not participate in some health plans, that services normally covered by your health plan will not be reimbursed by health plan, nor can you or MD24HouseCall Physicians bill your health plan for services. You may seek your health plan reimbursed services from a physician other than MD24HouseCall Physicians, and your secondary insurance coverage may not reimburse you for MD24HouseCall Physicians’ services).
◦Please note that for medico-legal reasons: no more than 90 tablets of any single type of Controlled-Drug Substance (CDS) medication (and no more than a three months’ supply of non-CDS medications) will be prescribed or dispensed per consultation (for example: we cannot prescribe two different narcotics or two different doses of the same narcotic during one house call or office visit or telemedicine consultation).