Patient Forms

To make your first visit to Copas Health quicker, please download, print and complete the following patient forms and bring them to your first appointment. If you are not able to print these forms and bring them with you, please come to your appointment 15 minutes ahead of time to fill them out.

Registration Form - Women who are new patients at Copas Health can download and complete this paperwork prior to their appointment. 

Notice of Privacy for Patients. Please read this booklet on HIPPA. After you have read it, please read and sign the Acknowledgement of Receipt of Notice Of Privacy Practices, which is included in the above link to patient forms.

Parental Consent For Minor 

If you are under 18, you may need your parent's signature before you can be seen. Please read the form carefully.

Health Symptoms Questionnaire - Print of this document, complete it and bring it with you to your appointment. It will help you think about your symptoms and facilitate a productive conversation with your provider.

 

Hormone Questionnaire for Women -  New patients should print this document, complete it and bring it to their appointment. It will help you think about your symptoms and give your provider a place to start analyzing possible treatments.

Medications, Supplements, Allergies and Other Providers Info - Please print and complete this record of medications and supplements you are already taking. This record helps our providers understand what measures you are already taking in your health journey.

Menstrual Calendar

Women can use this helpful form for tracking their cycle​ if they are trying to conceive or having trouble with their cycle.