New Patient Paperwork
You can now complete your new patient paperwork prior to your visit! For lactation visits, please fill out our Lactation Intake Form. If you are scheduled for women's health appointments, please fill out one of the appropriate forms listed below. You do not need to fill out more than one! If you do not know which form to complete, call our office. The forms are linked here:
Lactation Intake Form- for breastfeeding appointments only
Prenatal Lactation Intake Form- for prenatal breastfeeding appointments only
Contraceptive History Form - for contraceptive counseling and IUD insertion appointments.
Women's Health Intake Form- for all other women's health appointments, not for breastfeeding.
You have two options for completion:
1. Download, print, complete, and bring hard copy with you the day of your visit.
2. Download, save as (with your name) to your computer, then open and complete. Save a second time and email it back to us at firstname.lastname@example.org. We will print it and delete it to protection or your privacy.
If you are unable to complete either option prior to your visit, please plan to arrive 10-15 minutes early to your visit.
We value your time and expect that you value ours as well. If you need to cancel your visit we kindly ask for 24-hours notice. Because we understand emergencies and unexpected situations can arise, we allow all clients one same-day-cancellation without any fee. After this one, all cancellations made with less than 24 hours notice will be charged a $20 cancellation fee. After 3 missed visits/last minute cancellations, we reserve the right to not offer you appointments. You can cancel your appointment by calling our office or by clicking the link in the email confirmation that you received at the time of scheduling.
By engaging with care at BCHM you agree to pay for all services rendered to whatever extent is deemed your responsibility by your insurance. For breastfeeding visits, this includes responsibility for payment of care to newborns and infants as well as the breastfeeding parent. We offer courtesy billing of your insurance for all office services, however, it is your responsibility to provide us with current and accurate insurance information. It is also to important for you to be aware of your benefits, including any services that fall subject to a deductible or con-insurance, or require a copay. Since many of our services fall within the scope of preventative health services under the Affordable Care Act, and thus should be available with no cost sharing to you, we do not currently collect co-payments at the time of service. Should your insurance indicate you are responsible for a co-pay or co-insurance, we ask that you send payment for these promptly upon receipt of our invoice.