New Patient Forms

Women's Medicine.jpg

In order to get to know you and your health concerns better, we recommend completing the following forms prior to your appointment.  You are welcome to mail, fax, or bring them to your first appointment.  If there is difficulty in downloading these forms, please contact us to have them emailed or sent via USPS.

1. New Patient Intake

Download Female Intake Form Here

Download Male Intake Form Here

This form provides our doctors information about your current health concerns and past medical history.

2. Privacy Practices Notice

Download Here

If desired, patients can read and sign the “Privacy Practices Notice” before, or at the time of their appointment.

3. Consent for Care

Download Here

This form allows us to take your case and create a comprehensive treatment plan.

4. Email Consent

Download Here

Our doctors provide email communication with patients as a convenience.  Please read through the policies of email communication.

5. Records Release

Download Here

Please provide any pertinent blood work, imaging, or pap results prior to your initial appointment.  This health information can be from the last year or two.

6. Diet Diary

Download Here

The four-day “Diet Diary” is used as a tool to help our doctors better serve you and your health plan ~ it is not a tool of judgement.  You are welcome to complete a “Diet Diary” prior to your initial appointment 


"Whenever the art of medicine is loved, there is also love of humanity."
- Hippocrates


Dr. Jessica Hayman

Headshot 2017.jpg

Dr. Stephanie Bailey

Dr Stephanie Bailey.jpg
Sedona Vista.jpg