Patient Forms

If you are a first-time patient, please fill out the following documents according to the type of service and bring them to your first visit. 

Physician Office Visits
Occupational Therapy Visits

New Patient - Information 

New Patient - Information 

We're happy to help.

Our excellent office staff are available to answer any questions you may have.  Reach us by phone or send us a message online.

New Patient - Medical History

New Patient - Medical History

DASH Questionaire

Other Forms

Request for medical records to be sent to Bel Air Center

Request for Bel Air Center to release your records

The staff at Bel Air Center for Plastic and Hand are always happy to address any of your questions.  We understand that every patient is unique, and specifically aim to cater our care to reflect our patients' needs.  



Bel Air South Professional Center

2012 South Tollgate Road, Suite 100

Bel Air, MD 21015

Ramon A. DeJesus, M.D., FACS

Mathew A. Thomas, M.D.

Eric Davies, PA-C

Rachel Pigott, OT, CHT

Stefanie Stevenson, OT, CHT

Affiliated with:

University of Maryland Upper Chesapeake Health

University of Maryland

Johns Hopkins University

Office Hours:

M-F  8:00am - 4:00 pm