OB / GYN PRACTICE FORMS
When you provide a check as payment, you authorize us to use information from the check to make a one time electronic fund transfer from your account, or to process the payment as a check transaction. Click here to download
Financial Policy
Thank you for choosing us as your health care provider. In order to serve you better we require that all patients read and sign our financial policy. It is your responsibility to understand whether your provider is In-Network to maximize your benefits. We will be glad to assist you on any questions you may have. Click here to download Financial Policy
HIPPA Notice of Privacy Practices and Acknowledgements
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. Click here to download HIPPA Notice of Privacy Practices
Patient Personal History Information
Click here to download Patient Personal History Information Form
Office Patient Registration and Insurance Information
Click here to download Patient Registration and Insurance Information
Hospital Registration and Insurance Information for Surgery or Delivery
Click here to register. When registering please choose either obstetrical or surgical pre-registration, and pull-down for memorial city location.