Dr. Marc Rubinstein, D.D.S 2440 Research Blvd Suite 120, Rockville, MD 20850
Dental History Record - Form Download
When filling out this form please fill entire form to the best of your knowledge making sure that all medical history is accurate and precise.
All information on this for is considered confidential and will not be released or used other than Marc Rubinstein DDS and his dental staff.
Patient Registration - Form Download
This form is to keep an accurate record of your contact information. All information is considered confidential.
Financial Agreement - Form Download
This agreement is to inform the patients of his or her responsibilities upon time of payment whether personal or Insured.
First Visit Forms
On your First Visit to Marc Rubinstein D.D.S. LLC, you will be required to fill out several forms. In order to expedite your visit, those form are available to download and fill out at your convenience. Just, print, fill out, and bring in.
If you have any questions our staff will be more than happy to help.
Give us a call at 301-963-3333
Notice of Privacy - Form Download
This form is an acknowledement of the 1996 Health Insurance Portability & Accountability Act and the protection of your health information.
Informed Consent - Form Download
Informed consent indicates your awareness of the negative as well as the positive aspects of dental or surgical treatment.
