General Patient Forms

General Patient Forms

If you are a new patient, please follow the steps below:

  • Request an appointment through MyChart (you will be guided through the steps to create a New Patient account); or, if it is during normal business hours, call PWHealth to schedule an appointment.
  • Whether or not you have scheduled an appointment, please fill out our New Patient Registration. You may complete this form online or print out the form and complete by hand.
  • When it is complete please print it out, sign it and bring it with you to your first appointment.

New Patient Form

Medical Records

Professionals for Women’s Health has changed the policy and process for the request of all medical records. In order to cover the cost of storage, copying and mailing there is now a per page charge for the release of any patient medical records. Please be aware that this decision was made in accordance with HIPAA and Ohio State Law. Each record request fee will vary due to the number of pages requested and postage costs.

It is important for those requesting medial records to be specific in what they are requesting, whether it is the whole chart or only specific portions. Once the Medical Records Coordinator has received the request and determined the charge for the records that individual will be notified.

All fees must be paid in full prior to the release of the medical records. Requests for medical records that have ended in the year 2003 or earlier will take up to 5 business days to process. We appreciate your patience. Reminder: That payment is accepted at any office location, or if you prefer, we can take the payment by phone with a major credit card for faster processing.

*Individual results are not guaranteed and may vary from person to person. Images may contain models.