To ensure our availability, we ask that this form be completed at least 2 weeks before desired date. Request made with less than 2 weeks’ notice may not be able to be accommodated.
Submitted request will be reviewed by the BHS staff who will then contact you by phone or e-mail to confirm your request. If you do not hear from us within 48-72 hours, you may reach out to us at 301.687.4310
This form is not for scheduling patient appointments, if you would like an appointment please call our office at 301.687.4310
or utilize online scheduling through the Patient Portal.