Thank you for choosing the Women's Specilaists of Houston at Texas Children's Hospital. For your convenience, we have made certain forms available for you to complete prior to your visit.
Please take a few minutes to read the following instructions before completing these forms.
New Patients
If you are a new patient, please fill out each of the forms listed below. Once you have completed each form, first print out the form to bring with you and then click on the "Submit" button on the form to send your information to our office before your first visit. The "Authorization to Disclose Health Information" form will need to be printed, signed and then faxed to our office at 713-797-0556.
Please remember to bring the printed copy of all forms with you to your visit. Also bring an unexpired, government photo ID to your visit.
Established Patients
If you are a returning patient and have had a change of insurance, address, name or other information, please take a few minutes to fill out the "Patient Information Form". If your last name has changed, please put both your previous and your current last name in the last name field. Print out the form to bring with you and then click on the "Submit" button on the form to send your information to our office before your visit. Also, please complete the "Review of Systems" form. You will also need to print out this form to bring with you and then click on the "Submit" button on the form to send it to our office
Please remember to bring the printed copy of all forms with you to your visit.