For your convenience and in an effort to reduce the amount of time spent in our office completing the necessary paperwork, Academy Women’s Healthcare Associates have made the forms available for download or you may fill them out online.

A Gift is Waiting for You at Academy Women’s Healthcare!

For Our Patients Who Are Now Scheduling Appointments...

For speedier service and your convenience, please bring the completed patient registration forms to your next/or first visit. Print them off from our website, completely fill them in with your current information, then fax to 719-622-3400, or email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or hand them to the ladies at the front desk where you will be given a gift!

And now we have made it even easier! Just fill out and submit the forms online prior to your appointment and receive your free gift when you check in.

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pATIENT Health questionNaire

This health form is to be completed in order to obtain information regarding the patient's health history.

Please fill out the online form or print a copy of this form and complete it prior to coming for your first office visit.

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PATIENT REGISTRATION FORM

This registration form is to be completed every year in order to process insurance claims correctly and to have updated information on file at AWHA.

Please fill out the online form or print a copy of this form and complete it prior to coming for your first office visit. Online forms must be submitted 48 hours prior to your appoinment in order to give our staff time to process your paperwork.

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RECORDS RELEASE FORM

This form authorizes the release of health information to a third party.

When requesting release of your health records to a third party, please print a copy of this form. After completing it, fax (719.622.3400) or drop the form off at our office, attention: Andre Beach.

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INFORMATION AUTHORIZATION RELEASE CONSENT FORM

This form will allow us to release information about you, the patient, to individual(s) who are non-medical in relation. This consent form can be changed by the patient at anytime for any reason.

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RIGHT TO PRIVACY NOTICE

This form provides notice to all practice patients of their right to privacy of their protected health information (PHI). This policy describes procedures implemented by the practice to ensure the privacy of PHI.