Be Prepared and Informed With AWH’s Patient Forms and Documents

 

At Adriatica Women’s Health (AWH), we strive to make every visit productive and efficient. Plus, we’re dedicated to making sure you’re informed, up-to-date, prepared and empowered. With that in mind, we’ve created this clearinghouse of downloadable forms and documents for your convenience and highest-quality care.

New-Patient Paperwork

• Demographics Sheet
• Financial/Office Policies
• Notice of Privacy (HIPAA) Practices
• HIPAA Consent Form
• Patient Intake History
• New Patient Packet – Annual Appointment
• New Patient Packet – Problem Appointment
• New Patient Packet – Prenatal Appointment

 

Established-Patient Annual Paperwork

• Interval Gynecological History
• Demographics Sheet
• Financial/Office Policies
• Notice of Privacy (HIPAA) Practices
• HIPAA Consent Form

 

Pregnancy Paperwork

• Prenatal Genetic Screen

 

Authorizations

• Consent to Treat Minor Patient
• Confidentiality Agreement for Minor Patient
• IUD Benefits Request Form

 

Medical Records

• Records Release Form – to request your previous records be sent to Adriatica Women’s Health.
• Records Request Form – to request a copy of your Adriatica Women’s health records.
• All completed medical records requests should be emailed to ckail@adriaticawomenshealth.com

 

Patient Survey

• Patient Survey

 

Notices

• Nondiscrimination Statement

 

For more information, or to schedule an appointment, call (972) 542-8884. You can also schedule an appointment using our easy online form.