Patient Forms

Please print and fill out the following forms before your visit to cut down on your wait time.

If you can’t, we’ll have them waiting for you. Please arrive a few minutes early so you can fill out the forms in our office prior to your scheduled appointment time.

Patient Information Sheet

Financial Policy

Gynecelogic Patient Intake History

Privacy Policy

Privacy Policy Acknowledgement

Pelvic Pain and Urgency/Frequency Patient Symptom Scale

Pelvic Floor Dysfunction Checklist

Alliance for Women's Health Inc
310 South Cable Road
Lima, OH 45805
Phone: 419-228-1000
Fax: 419-227-3085
Office Hours

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