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       Locations: Exton PA and Paoli PA   »  Click for Directions
Phone: (610) 280-3636
Great Valley OB/GYN Family

Great Valley Ob/Gyn | Forms

Health History Form

We are in the process of setting up a new electronic medical record (EMR) system. Unfortunately, this means that the first time we see you, we will need to enter all of your information. If you are able to fax (610-280-1569), mail or drop off the forms at least a few days before your appointment, it will greatly shorten the time you and all other patients need to spend in the office, and maximize the time we have to address your medical concerns. We do not want to keep you waiting any longer than absolutely necessary.

There may be personal questions on the “Health History Form” that you do not wish to answer. That is fine. We realize that a lot  of the information requested may already be in your chart, and we will be happy to fill in things like dates that you cannot recall. Nonetheless, as a check for accuracy, we do need to ask you to complete the paperwork.

Health History Form – download this PDF 

Patient Financial Policy – download this PDF   Please review this policy before your visit.

Patient Registration Form – download this PDF   Please use this form to update your registration information.

Patient Authorization to Disclose Information – download this PDF   Please use this form to designate how you would prefer our office to notify you of test results and other information.

Authorization for Release of Information – download this PDF   Please use this form if you would like us to send your records to you or to another physician.

HIPAA Notice of Privacy Practices – download this PDF

Please note that the above documents that are in Adobe PDF format require Adobe Reader to be viewed. If you do not have that, you can download it for free by clicking here.

To change the font size of any of the documents for reading them on your computer, press the Ctrl and – or + keys.

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