Listed below are some of the intake patient forms. Please download or print them and fill out and bring with you to your first appointment.
Eastside OB/GYN Patient Forms
Comprehensive Health History Form – Dr. Kent Davis, Dr Tsuang
Comprehensive Health History Form - Dr Dydell, Dr Wittman
Release of Information Authorization - Dr Kent Davis
Release of Information Authorization - Dr Dydell, Dr Tsuang, Dr Wittman
Financial Policies
All patients, please read the Eastside OB/GYN Financial Policy
Obstetrical Patients Only
Eastside OBGYN Obstetrical Fees
Circumcisions
Ultrasound Policy
Pregnancy FAQ from our Patient Education Portal
Medical Records
Medical records are confidential. To protect your privacy, your written permission is required before we can release any information from your records. Prior written permission is also required before we can release information regarding you or your medical care to your spouse or family. If you have been referred either from, or to another medical provider, it is customary to send them a report and we will do so unless your direct otherwise.
If you transfer care, we will provide your new physician with a copy of your records at no cost to you. Copying your records for any other purpose will incur a fee. If you request records for life insurance, a lawyer, or for yourself, you will need to pay the office for this service. The fees are set by the Dept. of Labor and Industries and we must abide by them.
Insurance and Payment Information
We strive to keep down the cost of your medical care without compromising its quality. You can help by paying your copay at the time of your visit. We contract with a wide range of insurance plans, PPO’s and HMO’s. For your convenience we can submit your claims directly for you. If needed, a member of our business office will be happy to discuss financial arrangements with you. If you are pregnant or require surgery, they will give you an estimate of your expenses for our professional services.
