David R. Brown, MD, PhD, PA Endocrinology, Diabetes, and Metabolism

Patient Forms

Want to save time during your visit with us? Please download, print, and complete the following forms and bring them to your first appointment.

Registration Form
The information we need to sign you up.
Register with Dr. Brown.pdf
Adobe Acrobat document [105.6 KB]

Notice of Privacy Practices
Our policies for protecting your privacy.
Notice of Privacy Practices.pdf
Adobe Acrobat document [217.4 KB]

My Medical History
The background information Dr. Brown needs to know about you.
Medical History.pdf
Adobe Acrobat document [10.4 KB]

My Other Physicians
The physician who referred you to Dr. Brown, and other physicians with whom you would like Dr. Brown to correspond.
Referring Physician Addresses.pdf
Adobe Acrobat document [4.4 KB]

My Glucose and Insulin Records
If you have diabetes, use this form to record your recent blood sugar levels and insulin doses.
Glucose and Insulin Records.pdf
Adobe Acrobat document [5.7 KB]

Don't forget to bring the following items with you:

Past relevant medical records, including blood test results, reports of X-rays, Sonograms, CT-Scans, etc., and reports from other physicans.
A complete and current list of all your medications, vitamins, nutrition supplements, etc.
If you are diabetic, bring your recent self-measured glucose records.
Your current health insurance information.

In Case of Emergency

Important telephone numbers:

Organization	Telephone Number
Emergency Services & Fire Department	911
Centers for Disease Control and Prevention	1.800.CDC.INFO (800.232.4636)
Poison Control	1.800.222.1222
Dr. Brown's Answering Service	1.301.552.0808