In order to provide you with the best possible care, we need the most up-to-date information about you. If you are a new patient, or an established patient who has not visited our office within the past three months, we will need an updated registration form at your next appointment.
We are pleased to offer you the opportunity to print our registration form at your convenience from this website. Please complete this form and bring it with you to your appointment to help reduce your waiting time.
When you come in for your appointment, you may be asked to sign a separate release form authorizing us to submit billing information to your insurance company. If you have any other questions, we will be happy to assist you at that time. Please remember to bring your insurance cards with you along with this form.
To print the Registration Form you must have the Adobe Acrobat Reader on your computer. Download this program free of charge by clicking on the Get Acrobat Reader button below. Follow the on-screen instructions, and the download will take just a few minutes to complete. This program will also help you access many other areas of our site.
If you already have the Adobe Acrobat Reader, click on Print Registration Form to print the form now.
Print Registration Form
What does FACOG Mean?
It stands for "Fellow, American College of Obstetricians and Gynecologists." ACOG is the nation's leading group of professionals providing health care for women. The American College of Obstetricians and Gynecologists:
Office Hours
Monday - Wednesday -Thursday -Friday 9:00am - 5:00pm
Tuesday - 9:00am - 7:00pm
Mogadore - 2nd and 4th Wednesday morning of each month - 9:00 - 12:00pm
For your convenience we have office hours everyday of the week. Please call the office for a time that is best for you.
Confidentiality and Medical Records
We are pleased to be able to offer you the ability to request your medical records online. We make it fast and easy for you to forward your records to another physician, or arrange to pick them up from our office. So that we can accommodate your requests as quickly as possible, please follow these easy steps:
If you have any questions about this release form or the status of your request, please contact us at the practice directly.
To print the Medical Records Release Form you must have the Adobe Acrobat Reader on your computer. Download this program free of charge by clicking on the Get Acrobat Reader button below. The download will take about ten minutes (this time depends on the speed of your internet connection and may vary slightly), and the program will help you access many other areas of our site.
If you already have the Adobe Acrobat Reader, click on Print Medical Records Release Form to print the form now.
If you already have the Adobe Acrobat Reader, click on Print Medical Record Release Form to print the form now.
Print Medical Record Release Form