Women's Clinic Forms

Women's Clinic

Women's Clinic SHS Clinic Forms

Please print and complete (in BLACK ink) the appropriate forms below and bring them with you to your appointment at SHS Women's Clinic.


	If you are a NEW patient to SHS and are coming in for an Annual Well Woman's Exam:
	Medical History form Payment Responsibility Privacy Practices Acknowledgement GYN History
	If you have been to the clinic before and are coming in for an Annual Well Woman's Exam:
	GYN History
	If you are a NEW patient at SHS and are coming in for an office visit for a female complaint:
	Medical History form Payment Responsibility Privacy Practices Acknowledgement GYN History GYN Special Problem Visit
	If you have been to the clinic before and are coming in for an office visit for a female complaint:
	GYN Special Problem Visit
	If you would like STI testing to be completed as a part of your appointment:
	Sexually Transmitted Infection Testing Form

To Schedule an Appointment Call:

813-974-7474

Established Patient Hotline:

813-974-1823