New Patient Information

Thank you for selecting Women's Health for Life, Inc. to provide your OB/GYN care!

To make your first appointment run smoothly, please download and complete the forms below and bring them with you to your first appointment. Any transferred records we receive from a previous physician are always kep confidential and will not be disclosed without your written permission.

HIPAA: If the patient is a minor, for any results to be released to the patient's parents, the patient must sign an authorization to release information form.

Our office hour are Monday thru Friday from 7:30-11 AM and 12-4:30 PM, except on Wednesday, when we have lunch from 12-1 PM.

All prescriptions and authorizations for renewals must be requested during normal office hours. Normal test results will be mailed to you unless you have a return appointment. Any abnormal results will be called to you.

Patient Responsibilites:

1. If you are unable to keep your appointment, you must notify this office at least 24 hours in advance.
2. If you are fifteen minutes late, your appointment WILL be rescheduled.
3. Please notify our office immediately of any changes in your insurance, address or phone number.
4. If we are providers for your insurance, you will be asked to pay your deductible or co-pay at the time of service. If you are self-pay you will need to pay for your visit in full.
5. We accept cash, check, debit and/or credit cards!
6. You are responsible to know how your insurance plan works
7. You are responsible to tell the nursing staff if your insurance requires you to use a certain lab (ex: pap speciman, cultures, labs, etc.)

Fees Not Covered by Insurace:

1. Third occurrence of not presenting for a scheduled appointment - $28.00
2. Prescriptions rewritten - $11.00
3. Disability, FMLA forms - $6.00 per form
4. Non-sufficient funds, returned check fee - $33

Please Bring the Following to Your Appointment:

1. All completed forms (availble for download below)!
2. Photo of yourself - like a driver's license (this photo will be returned).
3. Your insurance card.
4. Any questions for the practitioner

We are glad you have chosen us to provide your care. The mission of our medical practice is to provide women with the best of care. We treat all patients with courtesy and respect and we expect our patients to return the courtesy to our personnel.

FORMS TO DOWNLOAD AND RETURN

To download the forms you MUST have Adobe Reader installed on your computer. If you don't here is a link to install Adobe Reader. You may either open the document and print it, or to download it, right click on the link and select 'Save Target As...' (for Internet Explorer) or 'Save Link As...' (for Mozilla Firefox) then save it on your computer. Open the forms from your computer and print them out.

New Patient Forms (for GYNECOLOGY - NOT PREGNANT)
New Patient Letter
Patient Notice-of-Privacy Policy
Financial Arrangements & Medical Insurance Form
Authorization for Release of Medical Records
Patient Information Sheet
Gynecology Information Sheet

New Patient Forms (for OBSTETRICS - PREGNANT)
New Patient Letter
Patient Notice-of-Privacy Policy
Financial Arrangements & Medical Insurance Form
Authorization for Release of Medical Records
Patient Information Sheet
Gynecology Information Sheet
OB Information Sheet
Nutrition Questionaire