For your convenience, you can complete the forms below by downloading, printing, filling them out and bringing them with you to your first visit.
- Assignment of benefits form
- Acknowledgement of receipt of notice of privacy practices
- View our notice of privacy practices
- Medical history form
- Review of symptoms form
Release of information
In order for WVCI to release a patient’s confidential medical records to a third party, the authorization form below must be completed and signed by the patient. The authorization form can be mailed, hand-delivered, or faxed to the attention of: Medical Records Department.
Gynecologic oncology forms
- GYN oncology patient pre-visit medical history form
- Pre-operative instructions
- Pre-operative bowel prep instructions
- What to expect in the hospital after surgery
- Care guidelines after surgery