Patient Information Forms and Consents
Click the title of the form you would like to view or print.
All the paperwork you need for your visit. Please sign and initial all areas.
As office policies can change, it is important for you to read, initial and sign this form stating you understand this policy.
This form explains our policies such as out of pocket expenses, insurance, phone calls and prescriptions. Please be sure to initial and sign all areas indicated. This form must be signed yearly due to possible policy changes.
Please be sure to update your demographics so we can be certain information submitted to insurance on your behalf is correct.
It is very important that you update your medical information frequently. This should be done if you are an established patient and there are any changes in your personal or family history or if you are a new patient. Please complete the form in its entirety.
Please complete this quiz if you are coming in for a Hereditary Cancer Screening. This is also required to be completed if it is time for your annual wellness exam.
If you have been seen for your annual or any gynecological issues elsewhere, it is important that you request that those records be forwarded to the Center for Women's Health.
Prior to having an IUD or Nexplanon inserted at the Center for Women's Health, this agreement is required to be signed prior to scheduling the procedure.