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New Patient
This form is for
Tulsa OB-GYN. The purpose of this form is to simply gather basic
information, spouse and/or insured party information, emergency
contact information, and medical insurance information about our new
patients. Feel free to download, print, and complete this form
before you come to Tulsa OB-GYN to ease the hassle of paperwork.
Dexa Patient Risk
Assessment
If you are
scheduled for a Dexa scan in our office, please print, complete this
form and bring it with you on the day of your Dexa appointment. This
is a medical test and must be ordered by one of our physicians. If
you believe you need one, please discuss it with your doctor, he or
she will determine if this test is right for you.
Medical Records Release FROM Tulsa OB-GYN Associates, Inc.
If you are
requesting Tulsa Ob-Gyn Associates, Inc. to SEND your medical
records to another physician/facility, please download and complete
this form. Remember to sign and date the release. You may mail
to our office or fax to 918-749-7806. Upon receipt your request will
be processed within 72 hours.
Medical Records Release TO Tulsa OB-GYN Associates, Inc.
If you are
requesting Tulsa Ob-Gyn Associates, Inc. to RECEIVE your medical
records from another physician/facility, please download and
complete this form. Remember to sign and date the release. You may
mail or fax to your previous physician's office/facility.
Medication Record
To ensure we have
a current list of all medications you are taking, prescription and
non-prescription. You may download this form, fill it out and bring
it to your next appointment. *Remember to list allergies to
medications, allergic reactions to contrast dye, adhesive/tape,
peanuts, shellfish, eggs, iodine, etc. If youa re unsure, write it
down and ask the nurse or physician when you come in for your
appointment.
Mirena
Benefit Verification
If you and your
doctor have discussed the Mirena and you are ready to order,
download and complete this form. Mail the completed form back to our
office or fax to 918/746.2252. Our business office will gather
insurance benefits and contact you in 10-14 days with your copayment
information.
Paragard
Benefit Verification
If you and your
doctor have discussed the Paragard and you are ready to order,
download and complete this form. Mail the completed form back to our
office or fax to 918/746.2252. Our business office will gather
insurance benefits and contact you in 10-14 days with your copayment
information.
Urodynamics Test Pack for Patient
If you are
scheduled for Urodynamics testing in our office, please download and
fill out all forms in this questionnaire. You will need to bring the
completed forms on the day of your scheduled Urodynamics Testing.
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