Before your visit, we encourage you to download and complete the appropriate paperwork available below. The forms must be completed in their entirety and turned into our office 24 hours in advance of your scheduled appointment time or your appointment will be rescheduled. Should you have any questions, please do not hesitate to contact us.

 

Patient Information Packet

  • New Patient Packet

    • Please complete before your first visit

  • If you are a New Patient (non-obstetrical) email paperwork too:

           midlandwomensclinic1@gmail.com

  • If you are an New Patient (obstetrical) email paperwork too:

           arodriguez@midlandwomensclinic.com

  • Obstetrics Paperwork (New Patient or Established)

    • Please complete before your first visit

  • Please email paperwork too: arodriguez@midlandwomensclinic.com

Mammography Patient Forms

  • Mammography Paperwork                                                                                                                         Please complete before your appointment and bring the appropriate paperwork with you

Medical Records Request/Transfer