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Patient Forms
Please click on the link below for the form or document you wish to print, fill it out completely and bring it to your appointment or fax it back to us before your visit at 410-367-2474.
New Patients
After making your first appointment, visit your myChart account to fill out our new patient questionnaire. If you have any difficulty, you may print this form and fill it out completely before your appointment to avoid any delays in your care.
If You Are Pregnant
- Practice Welcome and Pregnancy Resources
- Scheduling Your Nuchal Translucency and Detailed Anatomy Ultrasounds
- Birth Defect Risk Assessment Request Form
If You Are Having Surgery
Medical Records Request
A medical records request can be made via MyChart or by faxing the following form to our office at 410-367-2474:
Records Request or Release Form
** Please note that unencrypted e-mail sent over the Internet is not secure and may not remain confidential; thus, any information sent by email is sent at the sender's own risk. We encourage the use of a fax machine instead.
Disability Form Information
For over 34 years, Signature OB/GYN has worked hard to provide our patients with quality healthcare in a caring and professional manner. During that time, we have always provided administrative services for our patients at no additional cost. Despite the increasing amount of administrative work and costs that third party payer systems have created, we have resisted passing along these costs to our patients. Unfortunately, increasing expenses within the world of health care make it difficult for us to continue to simply absorb these losses.
Effective immediately, we will require a fee of $20 to be paid prior to the completion of forms, including disability, FMLA paperwork, and insurance applications. It is important to understand that these forms have become increasingly more complex and occupy a fair amount of time of both employees and medical providers as well as incur the cost associated with copying. In most cases, the medical record needs to be obtained and carefully reviewed before the appropriate disability information can be captured. The form then needs to be completed accurately, copied, signed and returned to the chart. Our fees are designed to offset the labor costs associated with this process and continue to provide this valuable convenience to our patients.
We believe that by implementing these changes we will ultimately be better able to serve the needs of our patients by focusing and investing our finances and efforts specifically on patient related health care services.
Surgical Form Information
During pregnancy some women may require an obstetrical surgery, i.e. a cesarean section or cervical cerclage. Our surgical coordinator will be responsible for the posting of your surgery. You and your doctor will decide the actual procedure and general logistics of your surgery but our surgical coordinator will schedule the actual timing, preoperative lab work and precertification that will be required.
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