Forms and Documents
Health history forms. If this is your first visit or the first time you have seen us in the last three years, visit the patient portal or download forms to complete before your appointment:
Medical Record 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.
HIPAA (Health Insurance Portability and Accountability Act). This federal privacy legislation ensures Women's Healthcare Associates maintains a continued high degree of confidentiality regarding your personal health information.
For patients who are seeing Dr. Susan Hobson, Dr. James Stempel or Dr. Richard Hamilton for the first time for an issue related to incontinence or pelvic support: please print and complete the Urogynecology Patient Intake Form and bring it with you to your first appointment.
For patients who are being seen for issues related to urinary incontinence: Please print and complete this voiding diary prior to your appointment. You will need to choose a 24-hour period where you can measure your intake and voiding amounts.
*To read and print forms, use the free and easy-to-use Adobe Acrobat Reader.