Call 814.835.8164 To Make an Appointment

Patient Forms

Forms_TypingYour first visit is an opportunity for us to get to know you better.  We will ask you about your past medical history, your past and current lifestyles and even about your future goals.  In order to be more prepared, please download the form packet and have it completed prior to your visit.

Once you have decided to continue or transfer your care to Women’s Wellness & Gynecology, please print the Release of Records/Transfer of Records Form. Mail or fax the completed form to the office currently in possession of your records. Please request all prior records be forwarded to us, so we may provide you with the most appropriate care.

Once you have made your appointment with Women’s Wellness & Gynecology, you should review the HIPAA Policy (only print out the form if you want a copy for yourself). If you wish to complete your paperwork before your appointment to save time at the office please print and complete the New Patient History Form, and Registration Form. If you have given Women’s Wellness & Gynecology your email address, you should receive an invitation to your own Patient Portal (also accessible from this site’s Home page), where you may sign in and complete these forms and submit them online using your computer or tablet device. Please note this electronic process may still be undergoing changes to make the process more efficient.

 

Release of Records / Transfer of Records Form

Registration Form

New Patient History Form