Printable New Patient Forms for your convenience

Prior to your first visit, please download the following patient forms:

Health Questionnaire

New Patient Information
Patient Information & Authorization
Financial Policy
*Acknowledgment of Privacy Practices

 

*Prior to signing the “Acknowledgement of Privacy Practices” (see link above) please read the HIPAA Notice of Privacy Practices.

 

Please print, fill out and bring these forms to your first appointment. You should also bring your insurance card. We will need to copy it for our records.

 

When being referred by another physician, please bring copies of your medical records and test results.

 

If you have finished all this paperwork, please arrive 15 minutes prior to your appointment. If not completed, you will need to arrive 45 minutes early to be ready for your scheduled time.

Please call us at least 24 hours in advance if you need to cancel or change your appointment.

 

Medical Records Release Forms
 

Release medical records from another office to The Women’s Health Center

Release medical records from The Women’s Health Center to another office