Get New Patient Intake Form - Obstetrics And Gynecology Weill Cornell - Cornellobgyn

Completing the New Patient Intake Form is an essential step for new patients visiting the Weill Cornell Department of Obstetrics and Gynecology. This guide provides clear instructions to help users fill out the form accurately and efficiently online.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to retrieve the form and open it for editing.
2. Begin by entering your personal details: Include your name, medical record number (MRN), and the date of your visit.
3. Choose your physician from the list provided: Dr. Gelber, Dr. Grunebaum, Dr. Kalish, Dr. Landres, Dr. Lee, Dr. Pri-Paz, Dr. Sharma, or Dr. Wasden.
4. Indicate who referred you to the clinic and your age.
5. Fill out your primary care provider information and the reason for your visit.
6. Provide menstrual history, including the date of your last menstrual period, age at your first period, and age at menopause. Also, specify the frequency and duration of your menstrual cycle.
7. Complete the genetic history section by providing your ethnic background, your partner's age and ethnic background, and any relevant family history of genetic conditions.
8. In the gynecologic history section, enter your last Pap smear details, any abnormal results, and any past infections or conditions related to gynecological health.
9. Fill in your contraception and pregnancy history, noting if you are sexually active, your current method of birth control, and details about past pregnancies.
10. List any allergies you have, specifying the nature of those allergies.
11. Document your current medications, including names, dosages, and frequency of use.
12. Provide past and current medical history, including any significant medical diagnoses and their treatments.
13. Briefly outline your surgical history, detailing other relevant medical procedures.
14. Complete the family history section by noting the living or deceased status of close family members and any significant medical conditions.
15. Answer questions regarding your social history, including occupation, marital status, smoking, alcohol use, and drug use.
16. Review the systems section by indicating whether you experience any listed symptoms.
17. Once all fields are completed, you can save changes, download, print, or share the form as needed.

Start completing your New Patient Intake Form online today for a smooth visit to Weill Cornell Obstetrics and Gynecology.