Online Patient Registration

 
 
 
New Patient Forms
please print, complete and bring to your first visit.

 

 

This site is provided by The George Washington University Hospital in coordination with The George Washington University Hospital Attending Physicians' Association.

 
PatientInformation
 
PatientHistoryPage1
 
PatientHistoryPage2
 
PrivacyPractices
 
ReceiptofPrivacyPractices


 
 
 
Sara Imershein, M.D.
 

 
PROTECTING YOUR PRIVACY
This Web site has been secured to protect the privacy of information entered onto the Web site by the public, including electronic forms, online patient registration and all other information entered for purposes of communicating with our hospital. In compliance with the Health Insurance Portability and Accountability Act (HIPAA), your Protected Health Information/PHI (personal health information) will be encrypted when it is transmitted to the hospital. All reasonable precautions have been taken to protect this information so that it will be seen only by hospital staff authorized to view it.

 
   

 
PROTECTING YOUR PRIVACY
This Web site has been secured to protect the privacy of information entered onto the Web site by the public, including electronic forms, online patient registration and all other information entered for purposes of communicating with our hospital. In compliance with the Health Insurance Portability and Accountability Act (HIPAA), your Protected Health Information/PHI (personal health information) will be encrypted when it is transmitted to the hospital. All reasonable precautions have been taken to protect this information so that it will be seen only by hospital staff authorized to view it.