New Patient Forms
Please download and fill out these forms prior to your visit
All NEW Patients must have a photo ID on 1st visit.
- PATIENTS INFORMATION RECORD
- GYNECOLOGIC INTAKE FORM
- RECORD RELEASE FORM
- BONE MINERAL DENSITY
- BLADDER TESTING QUESTIONNAIRE
- NOTICE OF PRIVACY PRACTICES AND AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION (PHI)
- AUTHORIZATION FOR DISCLOSURE OF HEALTH INFORMATION
- RIGHT TO REVOKE AUTHORIZATION
- MINOR PATIENTS
Helpful Links
Insurance Providers
We are pleased to accept the insurance providers below.
For your convenience we also accept payments by Cash, Personal Check and all major Credit Cards.
This information is subject to change and we recommend that you contact the clinic at (318) 443-7222 to verify whether we participate in your insurance program.
