Forms

Below is a list of helpful forms and information
you can view or download.

You will need a PDF Document Viewer (such as Adobe Acrobat Reader) to view or print these forms. If you do not already have a PDF document viewer, please download and install one.

HIPAA Notice
Of
Privacy Practice

Semen
Analysis
Instructions

Instructions
For
Your IUI
Appointment

Cancellation
and
No Show
Policy

Consent
To Share
Confidential
Information

Medical
Records
Release
Form

FMLA
Authorization
Form

Questions? Contact Us.

Book Your Appointment Online

Our Services

Obstetrics
Gynecology
Fertility & Infertility
Colposcopy
Ultrasound
3D Mammography
Minimally Invasive Surgery
Cord Blood Banking
MonaLisa Touch
Aesthetics Procedures
Pelvic Floor Biofeedback Therapy
Physician Supervised Weight Loss

Our Services

“

what they’re saying

Dr. Gutierrez delivered my first baby and she made the whole process so relaxed and calming! I have pretty bad medical anxiety and she calmed all my fears and was so caring. I would absolutely recommend her to anyone!

Forms

Below is a list of helpful forms and information you can view or download.

Questions? Contact Us.

Our Services

Our Services

what they’re saying

Carys S.

Office Closure Notification

Below is a list of helpful forms and information
you can view or download.