Office Policies

Please review our policies and print and fill out applicable forms prior to your visit, to save time at your visit.

• Scheduling and Arrival
• New Patient Paperwork (also used to update for established patients)
  • Assignment of Benefits
  • Demographics Form
  • Office Billing/Financial Policy
  • Permissions for Verbal Communications
  • Receipt of Notice of Privacy Practices
  • Records Request to Transfer Medical Records from other offices to ours
• Ambulatory Surgical Facility Policies
• Lab Policies
• Note to Our Self Pay Patients
• Notice of Privacy Practices
• Records Request Form to Transfer Records from this office to another
• Women's Health Connection Philosophy on Nutritional Supplements
• List of Insurance Companies with Whom We are Contracted

Medical History Forms

You will be given a "bubble form" to fill out just prior to your visit, which will ask you many questions about your general health. This can’t be mailed ahead of time because it needs to not bend in order to be accepted by our computer scanner.

If you have specific problems, it is helpful if you can fill out the following forms ahead of time and bring them with you to your visit.

• Heavy Period History
• Bladder History
• Quality of Life Questionnaire - Bowel and Bladder Symptoms
• Painful Period History
• Functional Medicine/Hormone Problems History
• Sexual Function Questionnaire
• Interstitial Cystitis Screen
• Bladder Diary
• Bladder Symptoms Screening Questionnaire