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23 Bustleton Pike
Feasterville, PA 19053
Get Directions

Hours
Mon - Thu 8:15am – 3:00pm
5:00pm – 7:45pm
Friday 8:15am – 4:00pm
Saturday 8:15am – 11:00am

295 Buck Road, Suite 111
Holland, PA 18966
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Hours
Monday 8:15am – 3:00pm
4:00pm – 7:45pm
Tuesday 8:15am – 3:00pm
Wed - Thu 8:15am – 3:00pm
5:00pm – 7:45pm
Friday 8:15am – 1:00pm

910 2nd Street Pike
Richboro, PA 18954
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Hours
Monday 8:30am – 4:00pm
Wednesday Noon – 7:30pm
Thursday 10:00am – 3:00pm
Friday 10:00am – 2:00pm

PATIENT FORMS


Welcome to Holland Medical Associates. As a new patient, you will be required to complete some forms before your appointment. In order to make your first appointment go as quickly and smoothly as possible, please complete all forms and mail or fax them to our office prior to your visit or bring them with you to your first appointment, along with your most recent insurance card, a photo ID and your co-payment. If you’re a new patient, please arrive 20-30 minutes before your scheduled appointment.

Patients will be billed for their services after their appointments. We accept cash, check, VISA, MasterCard, Discover and American Express.

 

PDF TX-65Patient Information

 

PDF TX-65Authorization to Speak to Another Regarding Medical Care

 

PDF TX-65Consent for Financial Responsibility

 

PDF TX-65General Consent to Treatment

 

PDF TX-65Authorization for Access or Release of Protected Health Information

 

 

PDF TX-65Standing Consent To External Prescription History

 
 
 
Payment/copay is expected at the time of your appointment. We accept cash, check, VISA, MasterCard, American Express and Discover.

 

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23 Bustleton Pike
Feasterville, PA 19053
Get Directions

Hours
Mon - Thu 8:15am – 3:00pm
5:00pm – 7:45pm
Friday 8:15am – 4:00pm
Saturday 8:15am – 11:00am


295 Buck Road, Suite 111
Holland, PA 18966
Get Directions

 

Hours
Monday 8:15am – 3:00pm
4:00pm – 7:45pm
Tuesday 8:15am – 3:00pm
Wed - Thu 8:15am – 3:00pm
5:00pm – 7:45pm
Friday 8:15am – 1:00pm

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eCare Patient Portal