East Valley Women for Women FormsPlease complete and bring the following forms with you to your first office visit.Patient Information Patient Information FormYou will be directed to the Patient Portal to enter your demographic and insurance information Download “Patient Information Form” Patient_Info_Record.pdf – Downloaded 6904 times – 59.75 KB Download “Payment Policy Form” Payment_Policy.pdf – Downloaded 6299 times – 41.71 KB Download “Records Request and Release Form” Records_Release.pdf – Downloaded 11034 times – 118.19 KB Your Privacy Rights Download “Patient Privacy Rights” HIPPA_Notice.pdf – Downloaded 5766 times – 201.30 KB Please Note: This is a $25 processing fee for FMLA and Short Term Disability.
