|Authorization for Release of Medical Information|
If you are needing any of your health records we need this authorization filled out BEFORE we can release ANY information to you.
|Patients Information/Disclosure Agreement|
If you have not been seen in over a year please fill this out PRIOR to your appointment. We have to have an updated form yearly. If anything has changed, please contact our office to let them know.
|ACOG-FORM A- FRONT|
Please fill this form out PRIOR to your New Ob visit at our office.
Please fill this form out PRIOR to your New OB visit at our office.
|Minor Release Form|
Any persons under the age of 18 that will not been seen with their parent/guardian needs to have this filled out PRIOR to being seen at their appointment at our office.
|Patient History- Becky Ross|
If you are seeing Qiong Mu (Becky) Ross for Adult Medicine we ask you fill this form out PRIOR to your appointment.