First Visit Forms

Please fill out these forms and bring them and your co-pay with

you to your first visit with us.

This will allow us to better serve your needs.

Remember, there is a $25charge for "no- show" patients- those that fail to call 24 hours in advance if they are going to miss their appointment. Those arriving more than 15 minutes late may have to be rescheduled.

Our Phone Number is:

704-982-3400

Our Fax Number is:

704-982-3411

What Kind of appointment do I need?

Before calling to schedule an appointment with your female healthcare provider it is important to consider what type of appointment you need.

The Annual or Yearly Gynecological Exam: this is a Well Woman Preventive Health exam that every woman should do each year. It includes a review of your health history and health risks, a complete physical exam, Pap screening if indicated, breast exam, performing or ordering other tests like laboratory blood tests, mammograms, or other tests that may be indicated depending upon a woman's health status and age, and refills/changes on medications. The time allowed for this visit is to focus on those things just described.

A Problem Gynecological Visit : When there are specific problems related to your physical, emotional, or mental health, the appropriate appointment is a "Problem Visit".

Depending upon the extent of your problem(s) an appropriate amount of time can be scheduled to allow you and the provider to fully discuss the concerns you have without either of you being rushed through the appointment or other patients having to wait for their appointment. If you can provide the receptionist with enough information about the reason for your visit or request a longer appointment, she can schedule the appropriate amount of time for your visit. Our appointment blocks are 20 minutes and we allow one, two, or three 20 minute blocks depending on the needs of the patient. Besides the scheduling concerns to help you get the most out of your appointment, insurance companies will not reimburse your provider for performing both an Annual Exam and a Problem Visit on the same day.

For Women's Health wants to make your visit as comfortable and comprehensive as needed to meet your specific needs. That is your "special" time with us. You can help us provide the best care for you by scheduling the right appointment for your personal needs.

New Patient Forms

Please print each of these and bring them COMPLETED to your first visit:

Por favor copia cada una de estas formas y LLENELAS y trigalas en su primer visita:

Patient Registration Form

Patient History(part a)

Annual Exam (part a)

Annual Exam (part b)

HIPAA Consent

Record Release

Transfer of care

Food Diary

Forma de Registracion

Historia Fisica y Familiar A

Historia Fisica y Familiar B

Forma deHIPAA

Information for GYN Patients

Information for Pregnant Patients

Our office hours are:

Monday, Wednesday and Thursday: 8 AM to 12PM and 1 PM to 5 PM

Tuesday: 8 AM to 12 PM and 1 PM to 7 PM

Friday: 8 AM to 12 PM

305 YADKIN ST

ALBEMARLE, NC 28001

704-982-3400

	First Visit Forms Please fill out these forms and bring them and your co-pay with you to your first visit with us. This will allow us to better serve your needs. Remember, there is a $25charge for "no- show" patients- those that fail to call 24 hours in advance if they are going to miss their appointment. Those arriving more than 15 minutes late may have to be rescheduled.




Our Phone Number is: 704-982-3400			Our Fax Number is: 704-982-3411
What Kind of appointment do I need? Before calling to schedule an appointment with your female healthcare provider it is important to consider what type of appointment you need. The Annual or Yearly Gynecological Exam: this is a Well Woman Preventive Health exam that every woman should do each year. It includes a review of your health history and health risks, a complete physical exam, Pap screening if indicated, breast exam, performing or ordering other tests like laboratory blood tests, mammograms, or other tests that may be indicated depending upon a woman's health status and age, and refills/changes on medications. The time allowed for this visit is to focus on those things just described. A Problem Gynecological Visit : When there are specific problems related to your physical, emotional, or mental health, the appropriate appointment is a "Problem Visit". Depending upon the extent of your problem(s) an appropriate amount of time can be scheduled to allow you and the provider to fully discuss the concerns you have without either of you being rushed through the appointment or other patients having to wait for their appointment. If you can provide the receptionist with enough information about the reason for your visit or request a longer appointment, she can schedule the appropriate amount of time for your visit. Our appointment blocks are 20 minutes and we allow one, two, or three 20 minute blocks depending on the needs of the patient. Besides the scheduling concerns to help you get the most out of your appointment, insurance companies will not reimburse your provider for performing both an Annual Exam and a Problem Visit on the same day. For Women's Health wants to make your visit as comfortable and comprehensive as needed to meet your specific needs. That is your "special" time with us. You can help us provide the best care for you by scheduling the right appointment for your personal needs.
	New Patient Forms
Please print each of these and bring them COMPLETED to your first visit: Por favor copia cada una de estas formas y LLENELAS y trigalas en su primer visita:
Patient Registration Form Patient History(part a) *Annual Exam (part a)* *Annual Exam (part b)* HIPAA Consent Record Release Transfer of care *Food Diary*		*Forma de Registracion* Historia Fisica y Familiar A *Historia Fisica y Familiar B* *Forma deHIPAA*
*Information for GYN Patients*		*Information for Pregnant Patients*


Our office hours are: Monday, Wednesday and Thursday: 8 AM to 12PM and 1 PM to 5 PM Tuesday: 8 AM to 12 PM and 1 PM to 7 PM Friday: 8 AM to 12 PM

	305 YADKIN ST ALBEMARLE, NC 28001 704-982-3400