MedStar Good Samaritan Hospital

Request an Appointment

To request an appointment with a MedStar Good Samaritan Hospital physician, please fill out the form below. A representative will call you within one business day; however, it may take up to two business days to confirm.

If you would like to speak with someone directly, please call 443-444-4100, Monday through Friday, 9 a.m. - 6 p.m. Please note: We are not able to provide any medical diagnoses or consultations via phone or e-mail.

If this is an emergency, please call 911 immediately.

* required information

Requestor Information
I am requesting this appointment for someone else:
Daytime Phone Number* - -
What is the best time to contact you?
How did you hear about us? 
Patient Information
First Name* MI Last Name*
Home Address*
City* State* Zip Code*
Date of Birth* / /     Gender*
Reason for Contact*
Please describe your symptoms and/or existing medical condition.*

characters remaining

How long have you had these symptoms?

characters remaining

Have you been treated for this condition in the past?
Do you have current medical work-ups (MRI, x-rays, etc.) performed in the last 3 months?
If you are seeking an appointment with a specific doctor, please type physician name here.
Health Insurance Provider
Preferred day of week for your appointment
First Choice
Second Choice

Please note: When you register at any MedStar Health site, your information remains strictly confidential. As always, MedStar NRH Rehabilitation Network and our parent company, MedStar Health, respect your privacy. The information you submit is used for internal purposes only to help guide us in developing health information relevant to your needs. Read our privacy policy.