NEW PATIENT INFORMATION FORM

New Patient Registration Form


Contact Us

Preferred Physicians

Please rank order at least 2 physicians.


Dr. Steve A. Priddle

Dr. Mark J. Gros

Dr. Michael L. Newcomer

Dr. Katherine A. Goodpature

Dr. Rebeka L. Weber

Dr. Brittani J. Roles

Image size should be between 0 x 0 and 4920 x 4920

Please review to ensure the details are correct before completion.

By submitting this document I agree to the following office policies of The Women's Health Group:

  • Appointment no-show/late-cancellation fee of $25 will be assessed to patients who fail to give 24-hour's notice of a cancellation or reschedule. 
  • Surgery no-show/late-cancellation fee is $250.
  • All balances incurred are due upon receipt of statement. 
  • Balance is not paid after 3 statements will be turned to collections. 
  • Accounts turned to collections will incur a 20% admin fee due to our office prior to  scheduling future appointments.
  • Our office reserves the right to terminate patients for reasons to include frequent no-show or delinquent accounts.
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