Patient Forms

We encourage new patients to fill out all forms listed  in the New Patient section prior to your first appointment. If you do not complete the forms prior to your first visit, please plan to arrive 30 minutes early to complete the necessary paperwork. Please bring the forms along with a picture ID and your insurance card.

To help us provide you with the most comprehensive healthcare possible, previous medical records are vital. Prior to your visit please contact your last physician to obtain pap results, blood work, mammogram reports, surgery reports, obstetrical notes and other pertinent health history. Your records can be faxed to our office at 225-201-2111 or you can bring them with you to your appointment.

Did you know? You can fill out required forms through your Patient Portal.

Existing patients can complete many of the forms below through our Patient Portal. The Portal also allows you to make appointment requests, view lab results and renew prescriptions and even message your physician directly! To set up your personal Patient Portal, please call (225) 201-2000.

New Patients

  • Patient Information Form
  • Health History Form
  • Pharmacy Benefit Manager Consent
  • Financial Policy
  • Notice of Privacy Practices

Patient Information Form

Health History Form

Financial Policy

Medical Records Release

Pregnancy Questionnaire

Designation of Personal Representative

Notice of Privacy Practices

Louisiana Women’s Healthcare is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about the privacy practices at Louisiana Women’s Healthcare, download our Notice of Privacy Practices or call us at (225) 201-2000.