(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.
Wildflower OB/GYN follows the CDC masking guidance for COVID prevention, which is based on community transmission by county. It has been our position that out of an abundance of caution, we would not alter masking requirements in our office until the community transmission has sustained a two-week trend. Based on the current community transmission levels, Travis County has sustained a two-week trend at “substantial transmission” down from “high transmission”.
We are no longer requiring universal masking for patients, staff, or physicians. Masking is now optional. We are still limiting guests to the maximum of 2 guests per patient.
If you have fever, cough, shortness of breath, or any symptoms of Flu or Covid-19, please call to reschedule your appointment, and contact your primary care provider. If you, or your guests, come to the office with any of these symptoms, you will be required to leave the office immediately.
Thank you for your continued cooperation as we remain committed to keeping our patients, providers and staff protected.