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

Non Covered Services 2020

CHOB Financial Policy and Procedures   

Welcome to Pregnancy Letter 2.2020

Pain Management Agreement     

Narcotics in Pregnancy

Narcotics for Gyn Patients

Myriad Family Hx Breast Cancer Under 50 Screening 2020 

Pregnancy Financial Policy    

Notice of Privacy Practices      

Medications Safe in Pregnancy 3.2020                                                                                     



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