Our Mission

Community Giving

New Patients

Existing Patients

 

To make your visit more comfortable and hassle-free, we suggest you complete the following forms before your scheduled appointment.

• New Well Woman Packet. Complete these forms if you desire well woman care.

• New OB/GYN Packet. Complete the forms in this packet if you are a new OB/GYN patient.

New Well Woman Packet

The New Well Woman Packet (PDF, 44KB) consists of the following forms:

• Registration Form
• Financial Responsibility
• HIPAA Privacy Notice
• Patient Rights and Responsibilities
• Voice Message Authorization
• Financial Policy
• Systems Review

What is HIPAA?

New OB/GYN Packet

The New OB/GYN Packet (PDF, 628KB) consists of the following forms:

• Registration Form
• Financial Responsibility
• HIPAA Privacy Notice
• Patient Rights and Responsibilities
• Voice Message Authorization
• Financial Policy
• Genetic Questionnaire-Part 1
• Genetic Questionnaire-Part 2
• HIV Test Consent
• Liability Form