Returning Patient Forms

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Returning Patient Forms 2017-05-31T14:54:20+00:00
Please bring your completed forms to the office at the time of your visit and save yourself some time in our waiting room!

Rather than arriving 30 minutes early for your first appointment to fill out our new patient forms, you can conveniently complete them at home prior to your visit by printing them directly from this website.

Follow Up Annual Visit (138kb)
Family Member Medical Release (27KB)
Medical Records Release (365KB)

You can update your Follow Up Annual Visit form at home prior to your next visit by printing it directly from this website. Please bring the completed Follow Up Annual Visit form to the office with you and save yourself some time in the waiting room.

Medical Records Release to Another Physician or Hospital

If you want WSNM to release your medical records to another physician or hospital, please print out the Medical Records Release Form and give it to the WSNM medical assistant at your next visit or fax it to the WSNM medical office where you see your provider:

  • Downtown fax number: 505-247-9743
  • Northeast Heights fax: 505-338-3456
  • Westside fax: 505-890-5933

Medical Records Release to a Family Member

To authorize WSNM to release your medical records to a family member, please fill out the top portion of the Family Member Medical Release and give it to the medical assistant at your next visit or fax it to the WSNM medical office where you see your provider:

  • Downtown fax number: 505-247-9743
  • Northeast Heights fax: 505-338-3456
  • Westside fax: 505-890-5933
If you do not want to authorize Women’s Specialists of New Mexico, Ltd. to release ANY medical or appointment information to anyone, you should complete the bottom portion of the Family Member Medical Release.

Privacy Policy

At WSNM, the privacy of your medical information is always respected. See Our Policy