Administrative Downloads

Please, select the document you are looking for from the list below and print it. Some of these documents are for you to read first so when you come to the office, you can sign them in front of one of our receptionists; by reading the document in advance, you save time during your visits. Some of the documents need to be printed and completed with all requested information. These documents should be brought to the office and delivered to the front desk.

CONSENT FOR AMNIOCENTESIS

This is the consent form for amniocentesis. Please read carefully and write down any questions you may still have to ask the doctor during your office visit and before you have the procedure. You should be fully informed before you have any invasive procedure that might put the baby's life at risk.


CONSENT FOR CHORIONIC VILLUS SAMPLING CVS

This is the consent for the procedure. You must read it at home and understand it well. If you have additional questions after you read it, write them down and ask the doctor prior to the procedure during your visit.


CONSENT FOR FRAGILE-X, CYSTIC FIBROSIS, AND SPINAL MASCULAR ATROPHY TESTING

This consent is for the tested noted on the title of the document. Please read carefully and write down any questions you may still have to ask the doctor during your office visit and before you have the procedure. You should be fully informed before you have any invasive procedure that might put the baby's life at risk.


CONSENT FOR GENETIC SCREENING FOR ASHKENAZI JEWISH PATIENTS

This is the consent form for Ashkenazi Jewish patients. Please read carefully and write down any questions you may still have to ask the doctor during your office visit and before you have the procedure. You should be fully informed before you have any invasive procedure that might put the baby's life at risk.


CVS: INFORMATION FOR PATIENTS

This document provides most if not all of the information you need before you decide to have a Chorionic Villus Sampling (CVS). Read it carefully and write down all the questions that you may still have. During your visit, the doctor will answer all of your questions to your full satisfaction.


HIPPA Message Authorization

This document authorizes our practice to release information to you or to your home voice system.


HIPPA Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.


HIPPA Privacy practice acknowledgment

You will acknowledge that you have received the HIPPA related information.


INFORMATION ABOUT SELECTIVE REDUCTION IN PREGNANCIES OF HIGHER ORDER

Read the material carefully; this may be one of the most important decisions of your life. If there are any questions you might still have after you have read this document, write them down and ask the doctor during your office visit.


MATERNAL WELLNESS CENTER GROUP INTEREST FORM

Please fill out this form and bring it in to our office during your first visit.


PATIENT AUTHORIZATION FOR PRIVATE HEALTH INFORMATION

This authorization allows us to communicate your private health care information with other health care professionals who are involved in your care


PATIENT DEMOGRAPHICS AND FINANCIAL FORM

Print this form at home, complete all the requested information accurately and bring it along to your first visit.


PerinatalHistoryForm

This form is where we record your history for use in our record. Read it carefully so you can be familiar with the information you will be asked by the nursing staff when they call you to obtain your history.


Uniform Assignment of Benefits

This document is your permission to exchange information with your insurance and related entities in order to submit your claims.