Welcome New Patient

We are pleased that you have chosen to be a new patient with Greater Houston OB/GYN. You have made a good decision. You can complete our new patient forms  conveniently online by clicking here or, you can download each form below complete it offline and fax to us or scan and email to us.

Paying by Check

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

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 our Financial Policy form.

HIPPA Notice of Privacy Practices and Acknowledgements

This Notice of Privacy Practices and Acknowledgements describes how we may use and disclose your protected health information  to carry out treatment, payment or health care operations 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 and Acknowledgements.

 

Patient Personal History Information

Click here to download the Patient Personal History Information form

Office Patient Registration and Insurance Information
Click here to download the Patient Registration and Insurance Information form.

Hospital Registration and Insurance Information for Surgery or Delivery
Click here to register. When registering please choose either obstetrical or surgical pre-registration, and select the Memorial City location in the dropdown selection box.

Once you have completed all of the forms offline, please fax them to 713-600-4151. Or, for your convenience, you can click here to complete the forms online and have them sent to us.