Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.
"Dr. Vahora is such a passionate, incredible doctor!! She is very skilled at what she does, her staff is so kind, and she has always made me feel as if I am in wonderful hands. I will always recommend her for women of any age."
Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente
Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.
Financial Policy (PDF) – This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Notice of Privacy Practices (PDF) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully. Aviso de prácticas de privacidad (PDF)
Office Policy (PDF) – Describes new office policies as they relate to COVID protocols, cash payments, using our patient portal and our Kindness Policy.
Epion Check In Procedure – This flyer introduces you to our new smartphone check in procedure for all patient visits prior to your appointment – both new and returning patients. If you don’t have access to a smartphone, you can forward the link to your desktop for completion.
myPrivia Mobile App – Download “myPrivia” from the App Store or Google Play. With myPrivia you can start or join a virtual visit, securely manage your care, make an appointment and visit the 24/7 Virtual Clinic. For assistance installing or using myPrivia, please call (888) 774-8428.