Patient Forms

All patient forms are located inside our Patient Portal. We encourage you to log into the Patient Portal to complete all of our forms prior to your appointment. We also offer you the ability to complete the check-in process on your phone prior to your appointment.

If you are unable to create an account in the Patient Portal, you can expedite your first visit by printing the following forms, filling them out and bringing them with you to the office:

• Patient Demographics Form
• Past Medical History
• Review of Systems
• Return GYN Annual
• Return GYN Problem Visit
• Patient Pay
• Patient Resp. Form
• Notice of Privacy Practice
• Verbally Release Patient Information Authorization Form
• Financial Policy
• HIV
• Admin Consent

Please fill out one of the attached forms for us to release your records and send to the office:

• Patients requesting their records from Fairfax OB-GYN
• Patients requesting their records to be sent to Fairfax OB-GYN