Patient Forms

Cervical Biopsy

You can print the following forms out as needed, complete them at home, and bring them with you to save some time on the day of your appointment. (HIPAA Use & Disclosure for first time patients only). The documents are fillable PDF files. If you wish to fill it out electronically you will need to open the document, save it to your computer, then complete the document and print to bring it with you the day of your appointment.

Registration Form

HIPAA Use & Disclosure (First time patients only)

HIPAA USE AND DISCLOSURE FORM.pdf

Well Woman Visit Disclaimer for Additional Charges

Well Woman Visit Disclaimer for Additional Charges.pdf

Permission to Treat Minor Patient without Parent/Legal Guardian Present

permission to treat minor without parent.pdf

Hereditary Risk Assessment

Hereditary Risk Assessment

Gynecological/Obstetrical Questionnaire

Gynecological/Obstetrical Questionnaire

COVID-19 Update:

Practice protocols are being adjusted to protect our patients, staff, and loved ones. Please reference below information for guidance.
  • Telemedicine is now offered to patients for qualified appointment types, please call our office to schedule.
  • Have an appointment and concerned about COVID-19: All necessary precautions are being taken for the safety of our patients. OB appointments are being kept with some restrictions for prevention. If you have a wellness exam or other gynecological concerns, please contact our office for scheduling options.
  • Staying prepared for COVID-19: Our office is up to date with the Centers for Disease Control (CDC) recommendations. We are closely monitoring this evolving situation and our leadership and clinicians are in constant communication to strategize proactively in order to maintain readiness.
  • Resources: The CDC has resourceful information regarding: Pregnancy, breastfeeding, prevention, symptoms, and much more! Click on the link for additional information: https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html
Please contact the office with any questions or concerns. On behalf of your providers and staff, we look forward to seeing you stay healthy!

Call Us: 301.530.2235