Patient Resources - Eastwind Women's Health - Westerville, OH (2024)

If you are a new patient and are coming in for GYN care, please download and complete the New GYN Patient Packet:

This includes

• The Patient Information form.
• The Release of Information, Privacy Practice Acknowledgement and Payment and Financial Responsibility Form. Before signing this please-
• Read (and if you like, print and save a copy) of our Privacy Policy
• If you wish to have someone other than yourself have access to your medical information you need to designate them. We work very hard to comply with the HIPPA laws and protect your medical information. Without a designation, a spouse or other family member will not be able to call for information even on your behalf.
• Please read and sign the separate Eastwind Women’s Health Financial policy
• Please complete the Risk Assessment Questionnaire
• Please complete the Medical History Questionnaire
• If you are a minor and your parent or guardian is not going to be present for your visit, we need to have the Consent Form for Medical Treatment of Minors completed and signed by your parent or guardian in order for us to see you. This is located under a separate tab.
• If you wish to have records forwarded to us from previous providers, fill out the Request of Previous Medical Records form and send it to the appropriate address.

Whether you are new to our practice or are returning for another pregnancy, please download the packet.

• This packet contains information regarding our practice as well as useful information for you during your Please take time to read through it and do not hesitate to discuss questions that arise with your provider. Part of the purpose of this packet is to familiarize you with questions before your doctor or nurse practitioner bring them to your attention. There are also references to material that you might find helpful.
• Do not sign the form on Non-Invasive Prenatal Screening until you have had a chance to discuss this with your provider.
• Do read and sign the form regarding Maternity Ultrasounds
• Complete as much as you can in the Prenatal Record portion of this packet. You will have a dedicated appointment with one of our nurse practitioners to go over this and have your questions answered.
• Please fill out the Patient Information form.
• Read (and if you like, print and save a copy) of our Privacy Policy.
• Then, read and complete the page regarding Release of Information, Acknowledgement of Privacy Practices and Payment and Financial Responsibility.
• If you wish to have someone other than yourself have access your medical information you should designate them. We work very hard to comply with the HIPPA laws and protect your medical information. Without a designation, a spouse or other family member will not be able to call for information even on your behalf.
• If you are a minor and your parent or guardian is not going to be present for your visit, we need to have the Consent Form for Medical Treatment of Minors completed and signed by your parent or guardian in order for us to see you.
• Finally, please read our financial policy and acknowledge by signing and dating where indicated.

Follow these instructions if you are already established with our practice:

• If you are coming for GYN care, please fill out the two page form labeled Health Review

• If you are coming for the start of a new pregnancy, please fill out the New or Return Pregnancy packet.

• New GYN Packet
• New and Return Pregnancy Packet
• Established GYN Patient Packet
• Notice of Privacy Practices
• Request for Previous Medical Records
• Consent Form for Medical Treatment of Minors