Forms

Below are multiple forms that you will need to fill out based on your various recommended services or before proceeding forward with care. If you do not see the form you are looking for, please contact us at 316-683-6766


First Visit Forms

Patient Information

Privacy Notice

New Patient History 3 page

Limited patient waiver non covered services     

CHOB Financial Policy and Procedures   

Welcome to Pregnancy Letter

Pain Management Agreement     

Narcotics in Pregnancy

Narcotics for Gyn Patients

Risk Assessment for Hereditary Cancer Syndromes 

Pregnancy Financial Policy    

Notice of Privacy Practices                                                                                            



Surgery Consent Forms

Anterior & Posterior repair of the vagina                Bladder Neck Suspension

Vagina Hysterectomy                                                Laparoscopic Tubal Ligation

Abdominal Hysterectomy                                         LEEP Procedure

Dilation & Curettage


Other Information

Record Release From Another Office To College Hill

Record Release from College Hill to Another Office