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Pre-Registration Instructions

If you would like, you may complete the downloadable forms at home and bring them to your doctors appointment.

Downloadable Forms

Download the form that applies to you and or your child, print them out and bring them in with you.

• Welcome to Telemedicine Letter
• Authorization to Release Personal Health Information
• Pediatric Medical Records Release
• Review of Systems Form Partner’s in Women’s Health OB/Gyn ONLY
• Family Social Medical History Form New patients or patients that have not been seen in the past 3 years - Please use this form if less than 24 hours before your appointment

Pediatric Forms

Download the form that applies to your child, print them out and bring them in with you.

• Newborn Well Child Check
• 1 Month Well Child Check
• 2 Month Well Child Check
• 4 Month Well Child Check
• 6 Month Well Child Check
• 9 Month Well Child Check
• 12 Month Well Child Check
• 15 Month Well Child Check
• 18 Month Well Child Check
• 2 Year Well Child Check
• 3 Year Well Child Check
• 4 Year Well Child Check
• 5 Year Well Child Check
• 6 Year Well Child Check
• 7-8 Year Well Child Check

• 9-10 Year Well Child Check-Female
• 9-10 Year Well Child Check-Male
• 11 Year Physical-Female
• 11 Year Physical-Male
• 12-14 Physical-Female
• 12-14 Physical-Male
• 15-17 Physical-Female
• 15-17 Physical-Male
• 18-20 Physical-Female
• 18-20 Physical-Male
• ADD/ADHD Assessment for Parents
• ADD/ADHD Assessment for Teachers