New to our practice?  Welcome.  Please print and complete the following paperwork and bring it to the office for your first appointment:

All new patients:

• Practice information
• Patient information
• Medical history (Page 1) *
• Medical History (Page 2) *
• Insurance Certification and Release Authorization
• Financial Policy
• Privacy Practices (HIPAA) Acknowledgement

New OB patients:

• Obstetrical History
• Genetic Screening
• HIV Consent
• Deemed Consent
• Cystic Fibrosis Carrier Testing Information

Returning GYN patients:

• Patient Information
• Financial Policy
• Deemed Consent
• Privacy Practices (HIPAA) Acknowledgement

*Adobe Acrobat (.pdf) format, click here if you don't have Adobe Acrobat Reader and would like a free download*