Patient Forms
What is the patient portal?
The patient portal is a web-based service that allows patients to have secure access to portions of their electronic medical record and to communicate with our clinicians online about non-urgent medical and administrative topics.
How can the patient portal assist me?
The patient portal allows patients to manage their personal health information at their own convenience. You will be able to securely and confidentially:
- Exchange messages with our practice
- Review billing statements
- Request appointments
- Research health topics
- Review Personal Health Information
- Complete and update medical forms
- Update your profile and contact information
Please do not request same-day appointments via the patient portal. For urgent medical matters, please contact us during our regular office hours at (941) 379-6331. In case of a medical emergency, call 911.
Forms
If you choose not to create a patient portal account, you may provide information via paper by printing out the pages below. You must have Adobe Reader to view these files. To download Adobe Reader, click here.
New Patient Forms
Registration Form (pdf) This is for new patient who has never been seen at our practice before. It contains basic personal and insurance information.
Medical History Form (pdf) This form reviews your medical and family history. Please print out and complete this form prior to your arrival.
Obstetrical Forms
These forms are for patients newly pregnant or are transferring into our practice while pregnant.
Initial OB Packet (pdf) This packet includes all the initial OB forms and information. Please complete them prior to your arrival.
28 Week OB Packet (pdf) This packet includes the forms and information needed prior to your 28 week appointment.
Additional Obstetrical Information:
Cord Blood Form (pdf) This form reviews your options for cord blood banking.
Neurological Injury Compensation Association Information (pdf)
Medical Release Forms
Records Release (pdf). This form will allow you to obtain your records from another facility to Gulf Coast Obstetrics & Gynecology
Records Release (pdf). This form will allow you to release your records from Gulf Coast Obstetrics & Gynecology to another facility and/or yourself.
Mammogram Images Release (pdf).
Office Policy Forms
Patient's Bill of Rights (pdf)
Office Compliance (pdf) This form outlines a voluntary compliance program that has been adopted by our practice, which is intended to promote adherence to statues and regulations applicable to the Federal health care programs and their requirements.
Laboratory Testing (pdf)
Financial Policy (pdf)
In Office Procedures (pdf)