New Patients – (Both GYN and OB)

·  New Patient Registration Form

o     This form may be completed ‘on-line’ and submitted electronically (by executing the 'Online Patient Services' button above). If you prefer to print your own copy to complete, please click here for the PDF file.

    ·  Patient Referral Information

o    Because so many of our patients are referred to us by physicians, family, and friends, we have put a new system in place to thank those people with a Special Gift. Please provide the following information so we can better honor them. Please click here for the PDF file.

    ·  Medical History / Annual Interval Update Form

o    This form is part of the ‘on-line’ registration form.  If you chose the on-line option, this has already been completed.   If you printed the Registration form to complete, you will need to also do the same with this form.  Please click here for the PDF file.

· OB Risk Screening Questionnaire

o     This form is also available in our 'Online Patient Services' area if you choose to enter the information in that format.  This form is only required if you are scheduled for an obstetrical appointment.  Click here for a PDF file of the form  Page 1 | Page 2

· Financial Policies Acknowledgement

· HIPAA Privacy Notice

o     This is the text of the policy.  You will be requested to turn in a signed copy of the ‘Acknowledgement’ at the time of your appointment.  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.

· Arbitration Agreement

o     This form is for review only.  You do not need to bring this with you to your appointment.  You will be required to sign an original form that we will provide at the time of your appointment.

· Consent for Treatment of a Minor

o     Print and complete this form only if applicable.

· Records Request

o     This form can be used if you have been instructed by the appointment scheduler to bring certain records with you for your visit.  If records have been requested by us, please forward this completed form directly to your other physician well in advance of your appointment with OCWMG.

· 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. 

· Welcome Package

o     General information about the office that will assist you in understanding our protocols (hours, labs, prescriptions, etc.)