Patient Forms

Before your appointment with us, quickly and conveniently access patient forms from our practice.

Download Patient Forms

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at Please bring your completed forms with you to our office at the time of your visit.

Office Policies


Appointments can be made by calling our office during normal business hours.  If you need to cancel or reschedule an appointment, we request 24 hours notice.  Failure to give adequate notice can result in a $30 no-show fee.  If you have a true emergency, call us as soon as possible and we can give consideration to waiving the fee.  Frequent no-shows can result in dismissal from the practice.

After Hours & Emergency Care

If you are experiencing an emergency, dial 911 or head to the nearest emergency room. For all other calls, an on-call physician is available 24-hours a day, 7-days a week.  Please limit your after hours calls to emergencies such as labor, severe pain, or heavy bleeding.  We can serve your needs better if you anticipate problems and call during regular business hours.  If possible please call before going to the emergency room for an OB/Gyn issue.

Prescription Renewals

Prescriptions are renewed during normal office hours. In some instances, we may require that the patient be seen in our office prior to medication renewal.  Please anticipate your renewal needs-we are unable to refill prescriptions after hours.


All office visit copays are payable at the time of service. If you are self-pay, payment is due before you are seen.  We accept cash, checks, and most major credit cards and debit cards. Please contact our billing office should you have any financial questions or concerns.

Call us at (716) 439-9183