Forms

New Patient Registration Forms

These forms are available electronically as part of the self-check in process on the patient portal. You may also download all forms in this PDF packet. If you would like paper copies mailed to you, please contact the office to have a packet in English or Spanish mailed to you. Please bring all four (4) completed forms with you to your appointment.

• Registration Form
• Office Payment Policy
• Office Policies
• Privacy Policy

Records Release Forms

Below are links to download our office’s records release forms. Records release forms are required for our office to both release patients’ records and to obtain patients’ records from another provider. These forms must be signed by the patient and returned to our office prior to the records being released or obtained. Please be as specific as possible as to what records are being requested when filling out the form. Also note that our office does charge a $25 fee for the copying of records up to the first 10 pages; An additional fee of 25 cents applies to each additional page thereafter.

• Request to Release Records to Women’s Group for Health from Another Provider
• Request to Release Records to Other Provider or Patient