Patient Information

We appreciate the trust and confidence you have placed in our practice. In return, we are committed to providing you with the best health care possible.

We recognize that your time is valuable, and we will make every effort to see you at your scheduled appointment time. We would appreciate your patience if there is a delay due to unexpected circumstances. If you are going to be late for your scheduled appointment, please telephone before you come, as we may need to reschedule your appointment. If you need to cancel or reschedule your appointment, please call at least 24 hours in advance, as this will allow another patient to utilize this time on the schedule.

Please click on the each form listed below. You will find a Patient Questionnaire, HIPPA Acknowledgment and Financial Responsibility forms as well as a records transfer form. Please bring the COMPLETED forms with you (unless otherwise instructed) to your appointment, along with:

• Current insurance card(s)
• Driver’s license

Thank you for choosing Cedar Rapids OB-Gyn Specialists, P.C. for your care. Please feel free to call us with any questions or concerns. Our office hours are Monday through Friday 8:00 a.m. to 5:00 p.m.

Sincerely,

The Physicians and staff at
Cedar Rapids OB-Gyn Specialists, P.C.

Forms:

Please fill out the interactive PDF forms electronically and fax them to 319-363-1473 or bring them to your appointment.
Thank you.

• Notice of Privacy (HIPAA)
• Privacy Practices Acknowledgement
• Release Authorization
• Your Financial Responsibility
• Non-Discrimination Notice

New Patient Forms

• PT Questionnaire

OB Patient Forms

• OB Patient Questionnaire
• Common Medications Safe in Pregnancy

In-Office Lab Instructions

• Patient Instructions – 3 Hour Gestational Glucose Tolerance
• Patient Instructions – 1 hour Gestational Glucose Tolerance