New patients will be required to complete:
- Patient Registration
- Ob/Gyn Questionnaire
- HIPAA Forms
All patients will be required to complete the registration form.
Please print and complete the appropriate forms at home and bring them with your to save some time on the day of your appointment.
Forms
- CWC Patient Registration – personal information, as well as insurance, allergies, and medication information
- HIPAA Use & Disclosure Form – an acknowledgment of Notice of Privacy Practices
- OB/GYN Questionnaire – medical, obstetrical, and gynecological history of the patient
- Well Woman Visit Disclaimer – explanation and acknowledgment of well woman exam
- Treatment Permission for Minors – authorization from a parent or legal guardian to treat minor
- Notice of Privacy Practices
- Medical Realese Form