Patient Forms
Before your appointment with us, quickly and conveniently access patient forms from our practice.
Download Patient Forms
To view the forms listed below, you will need to download Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.
- Request an appointment securely online
- HIPAA Privacy Consent Form
- Patient Registration Form
- Family History Questionnaire for Common Hereditary Cancer Syndromes
- Sexual Health and Wellness Questionnaire
- Arbitration Agreement
- Medical Advice Through MyChart Messages
- CPMC Patient Booklet
- Surgery Deposit Agreement
- Financial Policy
New Patient Appointments & Cancellation Policy
To become a new patient, please contact our New Patient Coordinators at (415) 831-2160 or email us at appointments@goldengateobgyn.org.
Golden Gate OBGYN requires a $250 advance deposit to schedule a New Patient Appointment. This payment confirms your visit and is applied toward any out-of-pocket costs not covered by insurance.
Due to high demand and the resources required to prepare for each appointment, we require at least 48 hours’ notice for cancellations or rescheduling. Appointments cancelled with at least 48 business hours’ notice are eligible for a full refund of the advance deposit.
Deposits for appointments cancelled with less than 48 business hours’ notice or for missed appointments will not be refunded.
Telemedicine
Pacific Gynecology Surgical Group recognizes the convenience and safety of telemedicine for patients seeking gynecological care. As a result, they offer telemedicine appointments for a variety of services. If you have any questions or would like to schedule an appointment, please call us at (415) 426-7859.