We encourage our patients to print and fill out paperwork in advance. You may mail your completed forms (1775 Williston Rd., Ste. 110, So. Burlington, VT 05403); fax them (fax: 802-862-9637); or bring them with you to your appointment.
All forms below are Acrobat PDF files that you can download and print.
If you are a new patient, please fill out these forms:
Patient Information and Request For Medical Services (HIPAA)
(sign after reading the file below)
If you are a returning patient, please fill out this form:
Release of Records To or From Vermont Gynecology
If you are transferring your care to (or are seeking a consultation or second opinion from) Vermont Gynecology from another practice, please fill out this form and return it to that practice. (Or, if you do not have their address or fax number, you may send your signed release to us, and we will try to find the address or fax number and contact the practice on your behalf.) Or, if you would like to release your Vermont Gynecology records to another practice, please fill out this form and return it to us.
Information Forms and Procedure Consents
If you are having a procedure at Vermont Gynecology, we encourage you to read the appropriate Fact Sheet, sign the Consent, and bring the form with you to your appointment.
If you are having another procedure at Vermont Gynecology, please read, sign, and return:
When you come in for a surgical consultation, your doctor will give you a very detailed handout about preparing for surgery. It covers everything you will want and need to know about how to get ready for surgery; what it will be like at the hospital or surgery center; activity and diet instructions for your optimal recovery; shopping lists; nutritional tips, etc. Our patients say this is an invaluable tool for them and continue to refer to it every step along the way. While this process is very familiar to us, we know that it is new to you. We want you to be as prepared as possible, and we do not want you to have surprises. We are committed to preparing you as well as possible for this significant step in your life.
In addition to this handout provided by your doctor, you may also refer to the following helpful information from the hospital and surgery center where your surgery will take place: