NEW!!! For NEW Patients ONLY!
Fast Track Scheduling for Urgent Care, Annual Exams, and Routine Gynecologic Care
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Patient Portal Login - Returning Patients Only
We have placed these forms online for your convenience.
Please take the time to fill out the relevant forms before you come to your first appointment. This will save a tremendous amount of time and make your visit smoother and more comfortable.
You may bring them with you to your appointment or fax them to us at (212) 532-4362.
Required For ALL New Patients
Registration Information ** New Form – Complete Online
Please take the time to fill out the relevant forms before you come to your first appointment. This will save a tremendous amount of time and make your visit smoother and more comfortable.
You may bring them with you to your appointment or fax them to us at (212) 532-4362.
Required For ALL New Patients
Registration Information ** New Form – Complete Online
Pharmacy Information ** New Form – Complete Online
Acknowledgement of Receipt of Fees and Privacy Practices (updated 8_10)
Review of Systems (updated 7_09)
Review of Systems (updated 7_09)
Additional Forms for New Pelvic Pain Patients
(including women with endometriosis and vaginal pain)
Pelvic Pain History Form
For new patients suffering from chronic pelvic pain
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Please bring records from your current providers including
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The most recent progress note
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Operative reports
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Pathology reports
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Medication list
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Most recent ultrasound and /or MRI
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Please limit records to approximately 10 pages.
***Please be aware. There is a $40 charge for missed appointments or cancellations with less than 24 hours notice.
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Downtown Medical
Office Based Surgery, PC has earned The Joint Commission’s Gold Seal of Approval |
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