The Women's Health Institute

Forms

Prior to your first visit, please download our packet of forms, containing the following:
  • Health Questionnaire
  • Patient Information
  • Financial Policy
  • HIPAA Notice of Privacy Practices (NPP)
  • Acknowledgement of Receipt of NPP

Please read our HIPAA Notice of Privacy Practices (NPP) then sign the Acknowledgement of Receipt of NPP. Print and fill out the forms and bring these to your first appointment. You must also bring a valid government issued photo identification (drivers license or passport) and insurance card. We need to copy them for our records.

When being referred by another physician, please bring copies of your medical records and test results. If you need to have your records sent from your prior ob/gyn, please fill out a Record Release to The Women's Health Institute and bring it to your prior physician. Please let them know when your appointment is so that they can send us your records before you arrive.

If you have finished all this paperwork, please arrive 15 minutes prior to your appointment. If not completed, you will need to arrive 45 minutes early to be ready for your scheduled time.

To avoid a cancellation or no-show charge, please call us at least 1 business day in advance if you need to cancel or change your appointment.

If you would like us to send your records to another physician so that we may co-ordinate care with them or if you would like to give us permission to discuss your records with a family member, please fill out a Record Release from The Women's Health Institute and send it to our office.

Thank you.


Dr. Bernstein also aesthetic procedures at Rejuvia Medspa and The Laser Vaginal Rejuvenation Institute of West Palm Beachincluding Designer Laser Vaginoplasty® and Laser Vaginal Rejuvenation® as part of the Laser Vaginal Rejuvenation Institute of West Palm Beach. Feel free to ask us about any of these procedures or Exilis a non-surgical skin-tightening treatment.


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