Below are several useful forms. They are patient forms that may be downloaded and filled out electronically (or printed and filled out by hand) prior to coming to your appointment.

If you are coming in for your first appointment at AWH or you have not been seen here in over a year please access the "All Patients" folder below for the following information. Please review the Patient Rights and the HIPAA Notice pages. You can also print out these pages and keep them for reference. Please save all of the other forms from the "All Patients" folder to your computer and fill them out electronically. The gray areas on all of these forms are the areas that need to be filled out. To fill in an area, simply click on the appropriate gray area and begin typing. (The non-gray areas of these forms are protected and cannot be changed.) Once filled out, please print your forms and bring them with you to your appointment (our e-mail address is temporarily not accessible, therefore, please do not try e-mailing the forms back to us). If you would prefer not to save them to your computer, then you can print out the forms and fill them out by hand and bring them with you to your appointment.

• Demographics Form - this form is for your general information (name, address, etc.) and your insurance information.
• Privacy Practice Acknowledgement - acknowledges that you received the Patient Rights and HIPAA Notice Forms.
• Financial Policy - acknowledges that you will be responsible for co-pays and bills that are not covered by your insurance company.
• Pay Direct Authorization Form - authorizes AWH to bill your insurance company for you.
• Health History Form - informs your provider of your health history, your current medications, your allergies, and any current symptoms.

If you are coming in for your first prenatal visit (your first visit for your current pregnancy), then please also fill out the genetic questionnaire that is located below.

• Genetic Questionnaire - helps you and your provider determine what, if any, tests are necessary to rule out genetic abnormalities in your baby.

If you are coming in to see Dr. Mitchell-Springer or Dr. Ostrom for a urogynecology appointment (pelvic organ prolapse or urinary incontinence) please also access the "Urogynecology Patients" folder below and read the urogynecology letter. Also, you do not need to fill out the standard Health History Form but please fill out the rest of the new patient information and also fill out the Urogynecology Questionnaire and the Voiding Diary (these last two forms are also located in the "Urogynecology" folder).

• Urogynecology Questionnaire - a health history questionnaire that is specific to urogynecology (pelvic organ prolapse or urinary incontinence.
• Voiding Diary - helps Dr. Mitchell-Springer or Dr. Ostrom determine your level incontinence or other urinary issues.

Please remember to bring your insurance card(s) and a photo ID (e.g. drivers license) to your appointment(s). Also, please contact your insurance company prior to your appointment(s) and find out the following: your deductible, your office visit co-pay, and your insurance preferred lab. If you go to a non-preferred lab, your insurance may not cover as much or any of the cost and the cost will become your responsibility.

Attention Patients