MY CHASE BREXTON

Online Patient Payments

Existing patients can now make payments through our secure web site based on their patient statement.  Click here to make an online payment.

Forms

Below are some useful forms and information for our visitors.

If you wish, you may print out, fill in and bring in these forms prior to your first visit:

• New Patient Packet
  - Patient Demographics Form
  - General Consent Form
  - Medical History From
  - Acknowledgments Form
  - HIPAA Form
  - Patient Rights and Responsibilities
• Informed Consent to Treatment (Mental Health)
• Patient Information Form (Mental Health)
• Sliding Fee Scale Application
• Frequently Asked Questions about Chase Brexton's Sliding Fee Scale
  

Useful Information

• Patient Advisory Council
• Privacy Statement
• Patient Handbook - Mt. Vernon Center
• Patient Handbook - Randallstown Center

If you have any concerns about patient care and/or safety at any Chase Brexton location, please contact the Performance Improvement Coordinator at 410-837-2050, ext. 1352.  If your concerns are not addressed in a timely manner, you may contact the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) at 800-994-6610.