Forms

Many of our most commonly used patient forms are listed below. They are available in PDF format. If you cannot open the documents shown on this page, you will need to download the free Adobe Reader software.

New Patient Forms – All new patients should download this document. It contains the new patient letter, registration form, financial policy, and HIPAA policy information.
Medical Records Release – from your other doctor to us – OR – from us to another provider
Menstrual Chart – blank copy of a patient menstrual record chart
Promissory Note – payment agreement between patient and/or responsible party and Greensboro Women’s Health Care

Greensboro Women’s Health Care welcomes Dr. Jill Jertson

Greensboro Women’s Health Care welcomes Dr. Jill Jertson to our practice. Dr. Jertson is welcoming new and established patients for office and surgical gynecology needs.  Please call today and make an appointment! 

Gynecology Tips

If you are having bleeding in between your menstrual cycles, after intercourse, after menopause, or in a manner that is heavier or longer than usual, you may have a condition that needs further evaluation and treatment. Please call for an appointment so we can help resolve this with you!

Zika virus recommendations

Zika virus is a mosquito-transmitted virus that is associated with micocephaly in infants whose mothers are infected during pregnancy. For more information, please visit: www.acog.org/zika

New Patient?

For more information on insurances accepted, please visit our resources page.

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