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On this page you will find links to most forms that you may need in our practice. They should all be printed and filled out ahead of your appointment or request, thereby saving time on arrival to the office.
For new patients:
Please print and complete the following two forms, and bring the completed forms with you to your first appointment.
New Patient Registration and Office Policies (3 pages total – please read and sign them all)
New Patient History
HIPAA notice of privacy practices – for you to read prior to signing the acknowledgement form, and keep for your own records
For pregnant patients:
If you are a new patient to the practice, please print and complete the following form in addition to the four forms for new patients.
If you are already our patient, please print and complete the following form prior to your first prenatal visit.
Prenatal questionnaire
Release of information forms:
If you would like records transferred from another practice to Charles Street Ob/Gyn Associates, or from Charles Street Ob/Gyn Associates to another practice, please print and sign the appropriate form.
We will release your records to your requested recipient within 14 days of receipt of the form.
To obtain records from another practice, we will fax the release of information form to that practice and await a reply.
Release of information to Charles Street Ob/Gyn Associates
Release of information from Charles Street Ob/Gyn Associates
For patients scheduled for surgery:
Information on rescheduling surgery
Outpatient surgery instructions
Inpatient surgery instructions
Medication guidelines
Postoperative instructions for LEEP of Laser of Cervix
Postoperative instructions for hysteroscopy, D&C, endometrial ablation
Postoperative instructions for operative pelviscopy including tubal ligation
Postoperative instructions for hysterectomies – TVH, LAVH, laparoscopic
Postoperative instructions for TVT and TOT
Postoperative instructions for inpatient procedures
Bowel prep and liquid diet instructions
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