Forms & Policies

Before your child’s appointment with us, quickly and conveniently access patient forms from our practice. To download the forms listed below, you will need Adobe Reader. 

Please bring your completed forms with you to our office at the time of your child’s visit.

Download Patient Forms

Injection Forms

• Injection Form for Injections given outside the office

Nausea and Vomiting with Pregnancy

• Nausea and Vomiting with Pregnancy

New Patient Forms

• Demographic Data
• New Patient Form Questionnaire: Page 1 | Page 2
• Health Record Update
• Payment Responsibility
• Pharmacy Consent
• Specimen Consent
• Patient Advocacy Program
• Notice of Privacy Practices: Page 1 | Page 2
• Patient Acknowledgement From Notice of Privacy Practices
• Policy for Treatment of Minors
• Office Procedure Policies

* New Patients: Be sure to print every form listed under New Patient Forms. As a new patient, you will need to complete all of these forms. *

OB Dental Sheet

• OB Dental Consent Letter

OB Ultrasound Consent for Gender Scan

• OB Ultrasound Consent for Gender Scan

Hysterectomy Information

• Outpatient Hysterectomy Information

Prenatal Medications

• Prenatal Medication Checklist

Records Request Release

• Records Request Release

Office Policies

Appointments

Appointments can be made by calling our office during normal business hours.

After Hours & Emergency Care

If you are experiencing an emergency, dial 911 or head to the nearest emergency room. For all other calls, an on-call physician is available 24-hours a day, 7-days a week.

Prescription Renewals

Prescriptions are renewed during normal office hours. In some instances, we may require that the patient be seen in our office prior to medication renewal.

Financial

All office visits are payable at the time of service. We accept cash, checks, and most major credit cards and debit cards. Please contact our billing office should you have any financial questions or concerns.