Patient Forms

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

Preferred Contacts (PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos

Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.

Office Policies

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. Política Financiera (PDF)

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)

HIPAA Privacy Notice

New patient forms through Phreesia.

Phreesia gives healthcare organizations a suite of applications to manage the patient intake process, including mobile registration. Mobile check-in allows you to complete pre-visit registration from your own device (any smartphone, computer or tablet) ahead of time and in the privacy of your home.

Women’s Specialists of Katy is partnering with Phreesia to save you time when arriving at our practice and to ensure that your health records will always be up-to-date. The information you enter is private and secure and will allow our team to better care for you.

Yes. Phreesia provides industry-leading privacy and security for our patients’ data. They are held to the same standards as Women’s Specialists of Katy related to protecting your family’s information. For additional information about Phreesia’s security visit https://www.phreesia.com/patient-privacy.

Yes. But once you have completed the initial registration, the next time will be much quicker because Phreesia saves your answers.

No. There is no app – you simply click the link provided in the text message or email. This allows you to securely answer any registration and medical questions necessary for your appointment.

Yes! Mobile registration is available in 20 different languages, and the PhreesiaPads in the office offer Spanish in addition to English.

That’s okay! If you have not completed your registration before the visit, see one of our receptionists, and they will be happy to send you a new link. Don’t worry, Phreesia saves information you entered previously.

You can talk with any of our receptionists in the clinic, reach out through the Contact Us page on Women’s Specialists of Katy, or send a secure message through the Patient Portal.