Bettini Emery Obstetrics & Gynecology

Thank you for making an appointment with us!

To expedite check-in at your appointment and to maximize the value of your time, please click on the appropriate links to download and print the registration forms. Please bring the completed forms with you to your visit.

New Patient:

Intake Form (Patient Demographic/Registration form)
Patient Medical History
Notice of Privacy Practice:HIPPA
Patient Consent (HIPPA)
Authorization to Disclose Medical/Financial Information document
Financial Arrangement/Insurance
Medical Record Policy

Note: Please remember to bring your insurance card and a list of
your current medications - include prescription medications
(name and dosage) and any vitamins or over the counter
medications that you take on a regular or occasional basis.

OB Patient:

Intake Form (Patient Demographic/Registration form)
Patient Medical History
Notice of Privacy Practice:HIPPA
Patient Consent (HIPPA)
Authorization to Disclose Medical/Financial Information document
Financial Arrangement/Insurance
Medical Record Policy
Cystic Fibrosis Testing Consent Form

Note: Please remember to bring your insurance card and a list of
your current medications - include prescription medications
(name and dosage) and any vitamins or over the counter
medications that you take on a regular or occasional basis.