Patient Forms

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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.

Medical History Form (pdf) This form reviews your medical and family history. Please print out and complete this form prior to your arrival.

Cord Blood Form (pdf) This form reviews your options for cord blood banking.

Prenatal Genetic Screening (pdf) – This form reviews the risks for genetic issues during your pregnancy. Please print out and bring to your first appointment.

Birth Plan (pdf) – This form outlines your choices for your birth plan.

Notice to Obstetric Patients (pdf)

Neurological Injury Compensation Association Information (pdf)

Help with Common Medical Problems in Pregnancy (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)

Portal Access Information (pdf)