Northwest Ohio Center for Urogynecology and Women's Health

Patient Registration / Questionnaires / Forms

All patients seeking an initial consult and appointment at the office must fill out a downloadable patient registration form packet pertinent to their visit. Links to the packets are shown below.

PLEASE READ THE DESCRIPTIONS CAREFULLY TO CHOOSE THE APPROPRIATE PACKET.

Filling out this packet ahead of time will greatly expedite the check-in process at your visit.

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Patient Registration Form Packets

Please fill out the General Women's Health Registration Form Packet if you are seeing Dr. Andrew Croak or Tracey Begley, or Deborah Higgins, for the following health issues:

Abnormal Pap Smear
Abnormal Uterine Bleeding
Adolescent Gynecology
Breast Health
Contraception
Endometriosis
Infertility
Osteoperosis
Sexual Dysfunction
Sexually Transmitted Diseases
Uterine Fibroids
Women's Health and Annual Well Exams

Please fill out the Urogynecologic Registration Form Packet if you are seeing Dr. Andrew Croak, or another provider, for the following health issues:

Bladder or pelvic pain
Interstitial Cystitis
Pelvic Prolapse
Urinary or Anal Incontinence
Urogenital Anomalies / Vaginal Cosmesis

Patient Questionnaires and Histories

Many of the patient intake questionnaires and histories found in the patient registration packets may also be independently downloaded below. They may be completed prior to your first visit or to update information on an as needed basis.

In addition, there are patient informational forms available for downloading based on educational needs for certain conditions.

Bladder Quality of Life Questionnaire

General Women's Health History

Urogynecology History