To serve you with the most efficient use of your time, please download and read the following documents under the PATIENT FORMS tab:

  • Welcome Letter
  • Notice of Privacy Policies for Bethany Women’s Healthcare

After that, please download and complete the following forms under the PATIENT FORMS tab:

  • Patient Registration Information Form
  • Patient Worksheet – Current Medication Information
  • Authorization to Release Medical Information (Page 1 of 2)
  • Acknowledgement of Review Notice of Privacy Practices and  Patient Privacy Policy (HIPAA related) (Page 2 of 2)

Finally, bring your completed forms as well as the following to your first appointment:

  • Photo I.D.
  • Your current medical insurance coverage information including:
    • policy holder’s name and date of birth
    • plan name
    • address
    • phone number
    • ID numbers including the policy number, group number and the member ID number

If you have questions, and especially if you are unable to complete these forms at home, please bring all of the information noted above and arrive 30 minutes before your scheduled appointment so that our front office staff can assist you in completing the necessary information.

Be sure to bring a list of your current prescribed medications, vitamin supplements and herbal remedies including the dosage of each one.

Your timely cooperation is greatly appreciated.  Thank you!

Note: A parent or guardian must accompany all patients under the age of 18 to this appointment.