To save time at your appointment, please download, print, and complete the applicable form below. All forms are PDF files and require Adobe Reader, which most computers already have installed. 

Abortion Client Forms:

• Combined Health Information Privacy Notice (HIPAA) Acknowledgement Form, Request for Information & Health History Form

Division of Reproductive Medicine Client Forms:

• Health History Form
• Health Information Privacy Notice (HIPAA) Acknowledgement Form (Read)

Gynecology & Wellness Client Forms:

• Combined Health Information Privacy Notice (HIPAA) Acknowledgement Form, Request for Information & Health History Form

Trans Health Initiative Client Forms:

• Patient Privacy Notice Authorization
• Consent Forms
• Medical History
• Revisit Form
   

General Forms:

• Records Release