Patient Forms
Thank you for selecting FEMCARE OB/GYN in Plantation, Florida for your obstetrical and gynecological care. To schedule an appointment with Dr. Robert Bass, please call us at (954) 472-2201 or you can book one online.
Once you have made your initial appointment, you may preregister by downloading, printing, and completing the forms below. Doing so prior to your visit will help speed up the new patient registration process.
Please be sure to bring forms with you to your first visit along with your insurance card, necessary referrals, and any diagnostic films or other test results that may have been ordered or performed by another physician.
Established patients can update forms online through our patient portal. If you need help accessing the portal, please call the office and we’ll be happy to help.
DOWNLOAD PATIENT FORMS:
- Patient Information
- Release of Records to Dr. Bass
- Office Policy
- Notice of Privacy Practices (HIPAA)
- Authorization for Treatment
BOTOX® FORMS
- Botox Medical History
- Consent to Botox Treatment
- Pre-Treatment Instructions
- Post-Treatment Instructions
ESSURE® FORMS
CIRCUMCISION
Please note: It may take a few moments to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat Reader for free by clicking on the icon below.
