Contact Us Form

Are you a new or returning patient?

Name

First

Last

of or returning

Phone

Date of Birth

Sex

Reason (optional)

checkbox

By checking this box, I agree to receive TEXT messages about appointments from Germantown Primary HealthCare at the phone number provided above. The SMS frequency may vary. Data rates may apply. Text HELP to 301-358-2030 for assistance. Reply STOP to opt out of receiving SMS messages.
I hereby confirm that I have read and agreed to the SMS Terms and Conditions and Practice Privacy Policy. I also affirm that I am at least 18 years old and have the authority to make this appointment.
I understand that SMS opt-in consent and phone numbers for the purpose of SMS are not shared with third parties or affiliates for marketing purposes.

Working Hours