Patient Forms

Health Forms:

If this is your first visit or the first time you have seen us in the last three years, visit our patient portal, or download forms to complete before your appointment:

• Health History
• Registration
• Financial Agreement
• Privacy Notice Acknowledgement
• Telemed Consent Form

Medical Records Release Form:

This helps us gather your records from your previous healthcare provider so that you don’t have to repeat a lot of your historical information.

• Medical Records Release
• Family Access to Medical Records

HIPAA (Health Information Portability and Accountability Act):

This federal privacy legislation ensures Northwest Women’s Clinic maintains a continued high degree of confidentiality regarding your personal health information.

• HIPAA Website

Privacy Notice:

• Privacy Notice

*To read and print forms, use the free and easy-to-use Adobe Acrobat Reader.