Patient Forms

Here at SW Florida OBGYN, we have taken the next technological step.  Our office has adopted Electronic Medical Records.  With this advancement, our office now utilizes a patient portal.  For our new patients, you can register your personal information and request appointments; for our established patients, the portal gives you the opportunity to enter your pin and access a variety of services to make your experience with our office much more efficient.


Patient Portal

What is the Patient Portal?

The patient portal is a web-based service that allows patients to have secure access to portions of their electronic medical records and communicate with our clinicians online about non-urgent and administrative topics.

Go to the patient portal website here

How can the patient portal assist me?

The patient portal allows patients to manage their personal health information at their own convenience. You will be able to securely and confidentially:

  • Exchange messages with our practice
  • Review and pay billing statements
  • Request appointments
  • Research health topics
  • Review personal Health Information
  • Complete and update medical history
  • Update your profile and contact information

Please do not request same-day appointments via the patient portal. For urgent medical matters, please contact us during our regular office hours at 239-275-4300. In the case of a medical emergency, please call 911.

Patient Forms

If you choose to not create a patient portal account, you may provide information via paper by printing out the pages below.

New Patient Forms/ Policies

Registration Form  This is for a new patient who has never been seen at our practice before.  These pages contain basic personal and insurance information, along with your medical and family history.

Patient Authorization Form

Financial Policy

Notice of Privacy Practices (HIPAA)

CDC List

Patient Bill of Rights

Records Release Form

Records Request Form

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