Due to Maryland licensing laws Dr. Martin may not participate as a preferred provider in any medical insurance program. However, if your insurance plan includes “Out of Network”  benefits these benefits apply to the services with Dr. Martin.  You are responsible for the full cost of your visits at or before your scheduled visit. We will supply you with a “super bill” which you may submit to your insurance for reimbursement. We cannot guarantee any amount of reimbursement by your insurance but we will do everything we can to make sure that you will have all necessary information needed from our office to maximize your reimbursement.

Many patients also utilize their Flex spending or Health Savings benefits.

New Patient Forms

Our patient forms are provided in Adobe PDF format, and can be downloaded to print and complete manually to bring with you to your visit.

If you do not have the free Adobe Reader, you can download it from Adobe’s website.


photo-collage_wildflowersYou can also complete the forms electronically and send them by email or print and then fax them to us at 410-296-4636.

To complete the forms electronically, make sure to first download and save the blank form to your computer. Right-click (Mac users, control-click) on the form title, and save the desired PDF form. Then open the saved blank form and complete it. Please click on instructions see additional typewriter tool instructions in the Adobe Reader™ software.

Introductory Consult Questionnaire
Introductory Consult Questionnaire

Consent Forms
Informed Consent
Phone & Email Consent

Health History Forms
Health History – Adult
Health History – Adolescent (ages 6-17)
Health History – Child (ages birth-5)

Assessment Forms
Diet Diary
Metabolic Assessment
• Neurotransmitter (NTAF) Questionnaire – Adult
Neurotransmitter (NTAF) Questionnaire – Child

Record Release Forms
Records Release