(Completed Yearly at Annual Appointment)
Please download and complete all 5 forms.
Once you have completed and printed the necessary forms, please fax them to us at (512) 479-0906 or bring them with you to your appointment. A secure fax line protects your privacy.
If any of your personal demographic information has changed – such as your name, address or insurance provider – please be sure to inform us before your next appointment. We ask that you please submit a copy of your new insurance card before your appointment so that we may verify your benefits prior to your arrival.
If you should have questions about any of the information in our patient forms, please contact our Austin obgyn office.
In line with CDC guidelines, face masks are still required to be worn by all individuals. We ask that you not bring children, family members, or ANY guests to your upcoming visit for the health and safety of our patients. If you have a fever, cough, shortness of breath, or other symptoms of Covid-19, please call to reschedule your appointment, and contact your primary care provider.
We do have a high risk and immune compromised patient population, so compliance to these guidelines are strictly enforced by our team.
COVID Vaccine Update
Our team is here to support your women’s healthcare needs. However, please note that we will not be offering the COVID vaccine in our office. For more information about the COVID vaccine, reach out to your primary care physician or your pharmacist.
Thank you for your cooperation as we remain committed to keeping our patients, providers and staff protected.