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Hennessey Obstetrics & Gynecology Forms
ABOUT YOUR VISIT
NEW PATIENTS

We ask that all new patients arrive to their appointment location 30 minutes early for their first appointment with our office. This is to ensure adequate time for the completion of administrative tasks (i.e. patient paperwork, insurance verification, payment)

 

Required at Time of Appointment

  • All prior medical records, when available

  • Completion of Patient Health History, found on the Patient Portal

  • Bring Driver’s License and Insurance Card

  • Complete OB/ GYN Paperwork

  • Depending on Insurance, form of payment for Service (i.e. Cash or Credit Card, we do not accept Checks)

 

 

EXISTING PATIENTS

All existing patients, we ask that you arrive to your appointment location at least 15 minutes early. This allows us time to make all needed updates to your demographic and insurance information while also, time to collect any required payments.

 

Required at Time of Appointment

  • All medical records, when available or requested

  • Driver’s license and insurance card

  • Be prepared to update patient paperwork, especially at annual visits

 

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FOR ALL PATIENTS

Failure to arrive for your appointment, as directed above, may result in the cancellation and reschedule of your appointment. In addition, a Late Fee or No-Show charge may be applied to the patients account.

 

If you must reschedule your appointment, please notify our office with 24 hours’ notice.

PATIENT FORMS

Please print and complete all forms in your category below and bring with you to your first appointment. Failure to complete all forms can delay your appointment.

 

Should you have any questions about any of these forms, complete them to the best of your ability, and bring your questions to our attention when you check in for your appointment.

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Forms are in PDF format, open in a separate window, and require a reader to open. Download the free reader, and follow the installation directions.

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NEW PATIENT FORMS

New Patient Minor Paperwork
  • Under age 18 (Parent and/or legal custodian must be present)

Print and complete this form packet

 
New Patient Paperwork
  • Age 29 & Under

Print and complete this form packet​

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New Patient Paperwork
  • Age 30 & Above

Print and complete this form packet​

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New OB patients
  • Have never been seen at our practice

Print and complete this form packet

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ESTABLISHED PATIENT FORMS
Established Patient Minor
  • Under age 18 (Parent and/or legal custodian must be present)

Print and complete this form packet​

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Established Patient Paperwork
  • Age 29 & Under

Print and complete this form packet​​​

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Established Patient Paperwork
  • Age 30 & Above

Print and complete this form packet​​​

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Established OB patients
  • Have been seen at our practice in the past

Print and complete this form packet​

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