904 Eastwind Dr, Westerville, OH 43081

2000 Newark-Granville Road, Granville, OH 43023

 

Hours: Mon-Thurs 9am-5pm

Friday 7am-2:30pm

CALL (614) 890-1914

Patient Resources

One of the least liked parts of coming to a medical office is filling out the paperwork. We do not have an easy way around this, but we now have the forms available on line so that you can complete them before coming to the office. If there are parts that you are uncertain about, feel free to leave them blank and then ask our staff for clarification, once you are at the office.

 

Please bring with you an official photo ID (drivers license or passport) and your insurance card or information.

 

The following will give you some guidance as to which forms to complete.

happy family

New Gynecology Patients

If you are a new patient and are coming in for GYN care, please download and fill out the following:

  • Read (and if you like, print and save a copy) of our Privacy Policy
  • After reading it, please sign the Notice of Privacy Practices Acknowledgment Form.
  • Please fill out the Medical History Questionnaire.
  • Please fill out the Patient Information form.
  • Please read and sign the Eastwind Women’s Health Financial Policy.
  • If you are a minor and your parent or guardian is not going to be present for your visit, we need to have the Consent Form for Medical Treatment of Minors completed and signed by your parent or guardian in order for us to see you.  If you wish to have someone other than yourself have access to your medical information you should fill out the Authorization for Use and Disclosure form and sign it. We work very hard  to comply with the HIPPA laws and protect your medical information. Without a designation, a spouse or other family member will not be able to call for information even on your  behalf.  If you wish to have records forwarded to us from previous providers, fill out the Request of Previous Medical Records form and send it to the appropriate address.

Forms

New Obstetrical Patients

If you are a new patient and are coming for Obstetrical care, please download and fill out the following:

 

  • Read (and if you like, print and save a copy) of our Privacy Policy, after reading it, please sign the Notice of Privacy Practices Acknowledgment Form.
  • Please fill out the New Pregnancy packet. There is information within this packet with which you should familiarize yourself.
  • Please fill out the Patient Information form.
  • Please read and sign the Eastwind Women’s Health Financial Policy.
  • If you are a minor and your parent or guardian is not going to be present for your visit,  we need to have the Consent Form for Medical Treatment of Minors completed and signed by your parent or guardian in order for us to see you.  If you wish to have someone other than yourself have access your medical information you should fill out the Authorization for Use and Disclosure form and sign it. We work very hard to comply with the HIPPA laws and protect your medical information. Without a designation, a spouse or other family member will not be able to call for information even on your behalf.

 

Established Patients

Follow these instructions if you are already established with our practice:

 

  • If you are coming for GYN care, please fill out the two page form labeled Health Review
  • If you are coming for the start of a new pregnancy, please fill out the New Pregnancy packet.