Forms

Notice of Privacy Practices
New Patient Medical History (Gynecology)
New OB History Forms (Prenatal)
Financial Policy for OB Patients
Consent to Treat
Medicare Forms
Consent to Release Medical Records (From LGH-Circle Health OBGYN)
Consent to Release Medical Records (From an outside facility)

** The Consent to Release Medical Records form must be completed and forwarded to your previous doctor’s office. This form provides your permission to obtain your medical records. Copying and sending your previous medical history can take a few weeks to process. Please send out the Consent to Release Medical Records as soon as possible.