New OB Patient

New patient obstetrical entry forms are listed below. All of these forms need to be completed and returned to our clinic at least 48 hours prior to your appointment. It is vital that the forms be returned to us in advance to best utilize both your time along with our physicians time. You can either print the documents or right click to download the pdf file. Please mail, email or fax us your entry forms as soon as possible. If you are an ob patient transferring care and are new to Bellingham OB/GYN, we require all obstetrical records from your current provider, prior to scheduling. If records are not received, your appointment may be rescheduled. Due to our obstetrical patient demand, it is imperative that you notify us if you need to cancel or reschedule an appointment.

Please note, effective August 1, 2018, a $100 deposit is collected from all obstetrical patients at their initial visit titled “Confirmation of Pregnancy”. In addition, a $50 deposit is required upon check in for both the Nuchal Translucency (NT) ultrasound {typically performed around 11-12 weeks gestation} and also the Anatomy ultrasound {typically performed around 20 weeks gestation}.¬†These deposits get applied towards any out of pocket expenses set forth by your insurance carrier for your ultrasounds. Ultrasounds {diagnostic testing} is not included in our Obstetrical Pre-Payment Plan.¬† Thank you for your understanding of these deposits.

 

adobe_pdf_file_icon_24x24 Communication Preference

adobe_pdf_file_icon_24x24 GYN HX

adobe_pdf_file_icon_24x24 Medical Health HX Form

adobe_pdf_file_icon_24x24 Obstetrical Patient History Form

adobe_pdf_file_icon_24x24 Past Medical HX