New patients ~ please fill these out and bring them with you or email them to firstname.lastname@example.org prior to your appointment. If you cannot do this prior to your appointment you must arrive 30 minutes early for paperwork and your medical assistant assessment.
Thank you for choosing us to help you with your Gynecological and Sexual concerns. Every patient joining this practice MUST HAVE a PRIMARY CARE PROVIDER for routine health care and access to Urgent Care when needed. At this office-based GYN practice, we do not do Obstetrics, Surgeries, General Medicine or Thyroid Management. We are not available for emergencies.
Mon 10am – 1pm
Tues – Thurs 8am – 4pm
We strive to provide our patients with exceptional care; so we ask you use the checklist of required forms to fill out and return to our office prior to making your first visit appointment. You are welcome to return the forms by dropping them off, or mailing them into the address listed above. We also accept records faxed to 603 516-5006 or emailed to email@example.com
- New Patient Forms Checklist
- Health History Form
- Contact Information Sheet
- General Information
- Terms of Service
- Liability Waiver
- Permission to Share Information
- Request to RECEIVE Protected Health Information (releases others to send info to us)
- Request to RELEASE Protected Health Information
- No-Show and Short-Notice Cancellation Policy Form
Bio-Identical Hormones Appointment
Please fill out all Gynocological Forms plus the Questionnaire for Bio-Identical Hormones. Also please read the information on Bio-Identical Hormones.
Sexual Counseling Appointment
Please fill out all Gynocological Forms plus the forms below. Make sure to fill out a questionnaire and medical history forms for each partner who will attend the appointments.