GYN - Established Patients (Annual/Well Woman/Other)

·        Interval Health Screen

o     For our patients who haven’t been seen in our office for over 1 year.

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·        Financial Policies Acknowledgement

o     You will only be asked to complete this form once for our office.  If you are unsure whether you have already completed this form for us, you might consider reviewing it here.

·        Demographic Changes

o       This is necessary only if there are changes to report

o       This document is our full Registration Form.  Simply
 complete the areas that have changed.

·        New Insurance – No Card Available

o      Use this form if you are in the process of changing
 insurance plans and you do not have your new insurance
 card yet.

·        HIPAA Privacy Notice

o    You will only be asked to complete this form once for our office.  If you are unsure whether you have already completed this form for us, you might consider reviewing it here.  Please note the special section on the form that allows you to designate other family members to have access to your information. Page 1 |  Page 2

·        HIPAA Privacy Notice ‘Acknowledgement’

o     Please note the special section on the form that allows you to designate other family members to have access to your information.

·        Secure Phone Option

o     It is our policy not to leave confidential information on message machines at our patient’s phones.  However, you may designate a phone number as ‘secure’ for leaving this type of information.  This optional form is available for that purpose.