Associates in Women's Care
Associates in Women's Care
6011 E Woodmen Road, Suite 320
Colorado Springs, CO 80923
719.591.6666
 
 
   Home
   About Us
   Educational Information
   Pregnancy
   Gynecology
   Registration Forms
   Maps & Directions
   Contact Us
   News
 

Slideshow image

 

Registration Forms
 

To eliminate the need to fill out forms when you come in for your first appointment, you can print and fill out these forms ahead of time.  Don’t forget to bring them with you to your visit!  Also, please remember to bring in a current copy of your insurance card so we can copy it for your chart. 

If you have an appointment for pregnancy, please fill out and print the following forms: 

Patient demographic/HIPAA Form

Registration form

Genetics Questionnaire/CYSTIC FIBROSIS

Insurance Questionnaire

Authorization to Release Healthcare Information***  

***To have medical records from a previous healthcare provider forwarded to our office, fill out and mail or fax that provider a signed copy of this form.


Forms are in Adobe Acrobat (PDF) format. To obtain a free copy of Adobe Reader, click here.

 

 
 

 

 


Since your web browser does not support JavaScript, here is a non-JavaScript version of the image slideshow:


slideshow image


slideshow image


slideshow image