Welcome to Alliance Obstetrics & Gynecology, PLLC.
In this packet you will find all the forms that must be completed prior to arriving.
The following is a list of items you will need to have completed and bring with you to your appointment.
Alliance OB/GYN Medical History
Confidential Communication of Protected Health Information
Valid Picture ID (Driver’s License/State ID)
PLEASE BE AWARE THAT RESCHEDULING WILL BE NECESSARY IF THE FORMS ARE INCOMPLETE AND/OR FAILURE TO ARRIVE 30 MINUTES PRIOR TO THE APPOINTMENT TIME.
If you are being referred to us by a physician or have an ongoing problem, please have the pertinent portion of your medical record forwarded to our office. If you are a self referral and have no ongoing problems, we do not need a copy of your medical records forwarded.
Prior to your office visit, please check with your insurance company to see if an authorization is required for your appointment. Also, please bring your insurance card so that we may copy it for our records.
This appointment time has been set aside for you and the provider to discuss your care. If you are unable to keep this appointment please notify our office 24 hours prior to your appointment. If you do not cancel your appointment in the designated time we may be unable to reschedule your appointment.
Thank you for choosing Alliance Obstetrics and Gynecology, PLLC for your health care.