NEW!!!
Fast Track Scheduling for Urgent Care, Annual Exams, and Routine Gynecologic Care
We have placed these forms online for your convenience.
Please take the time to fill out the relevant forms before you come to your first appointment. This will save a tremendous amount of time and make your visit smoother and more comfortable.
You may bring them with you to your appointment or fax them to us at (212) 532-4362.
Required For ALL New Patients
Registration Information (Updated May 2011)
Please take the time to fill out the relevant forms before you come to your first appointment. This will save a tremendous amount of time and make your visit smoother and more comfortable.
You may bring them with you to your appointment or fax them to us at (212) 532-4362.
Required For ALL New Patients
Registration Information (Updated May 2011)
Acknowledgement of Receipt of Fees and Privacy Practices (Updated November 2010)
Review of Systems (Updated February 2011)
Review of Systems (Updated February 2011)
General Consent to Treatment (Updated May 2011)
Additional Forms for New Pelvic Pain Patients
(including women with endometriosis and vaginal pain)
Pelvic Pain History Form
For new patients suffering from chronic pelvic pain
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Please bring records from your current providers including
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The most recent progress note
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Operative reports
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Pathology reports
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Medication list
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Most recent ultrasound and /or MRI
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Please limit records to approximately 10 pages.
For Patients Coming for Urodynamics and New Patients with Urinary Complaints
Voiding Diary (Updated April 2011)
Pre and Post Urodynamics Instructions (Updated May 2011)
***Please be aware. There is a $40 charge for missed appointments or cancellations with less than 24 hours notice.
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Downtown Medical
Office Based Surgery, PC has earned The Joint Commission’s Gold Seal of Approval |
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