Already have an appointment with the Division of Breast Surgery?
Please print out and complete your health history form below and fax it back to us at 877-376-2420 so that we may update your information in our new electronic medical record prior to your visit. Forms may also be mailed to The Division of Breast Surgery, 3800 Reservoir Rd., NW, Pasquerilla Healthcare Center (PHC), Fourth Floor, Washington, DC 20007.
MedStar Georgetown University Hospital
3800 Reservoir Rd., NW
Betty Lou Ourisman Breast Health Center
Lombardi Comprehensive Cancer Center
Washington, DC 20007