Registration and Health History Forms
New patients will receive an invitation to our secure Patient Portal after the first appointment is scheduled. Upon receiving the invitation, a new patient is asked to create a Patient Portal account and complete registration and history forms electronically. If you are unable to complete forms in the portal, you may print the applicable forms below, and bring completed forms to your visit.
- Registration Form – Required for all new patients
- Adult Female Health History Form – Required for new female patients, age 18 and up
- Adolescent Female Health History Form – For new female patients younger than 18
- Male Health History Form – Required for all new male patients
Specialty Consultation Questionnaires
Patients scheduled for an initial consultation for the conditions below are asked to create a Patient Portal account and submit specified questionnaire(s) prior to the consultation appointment. If you are unable to do this through the portal, you may click on a title below, print, and complete manually in advance of your appointment.
- Female Hormone Health Questionnaire – Required for Female Hormone Health Consult
- Male Hormone Health Questionnaire – Required for Male Hormone Health Consult
- Pelvic Floor Dysfunction Questionnaire – Required for Bladder/Bowel Control Consult or Pelvic Pain Consult
- Haven Medical Spa Intake Form – Required for Medical Aesthetic Services
Records Release Forms
- Records Release TO Women’s Wellness Center. To request records be sent from another healthcare provider to WWC. Send this request form to the provider from whom you are requesting records.
- Records Release FROM Women’s Wellness Center. To request records be sent from WWC to another healthcare provider.