Patient Information

Here are some of the forms we require patients to fill out for appointments.

New and Annual patients have to fill out Medical History Forms. If you are requesting a pregnancy test, you must fill out the Pregnancy Test Request Form. If you want an STD test, please fill out the Express Client Information Sheet. If you have no insurance and are a citizen between 18 and 39 years old, please fill out the State Pap Plus Program Form for reduced to no-cost services of paps, labs, breast exams, etc.

Please download, print, and fill out these forms prior to your appointment to help reduce waiting room time.

New Patient Medical History Form (PDF)
New Patient Medical History — Spanish (PDF)
Patient Information and Financial Policy (PDF)
Information and Financial Policy — Spanish (PDF)
Express Client Information Sheet (PDF)
Express Client Information Sheet -Spanish (PDF)
Emergency Contraceptive History (PDF)
Pregnancy Test Request Form (PDF)
Pregnancy Test Request Form-Spanish (PDF)
State Pap Plus Program Form (PDF)
State Pap Plus Program Form-Spanish (PDF)
Express STD Information Sheet (PDF)
Express STD Information Sheet — Spanish (PDF)