Patient Forms and Education Handouts

New Patient Forms

• New Patient Intake Form (Women’s Health Care Center at UWMC-Roosevelt) (PDF)
• Prenatal Visit Form (UW Medicine Shoreline Clinic) (PDF)

Surgery & Anesthesia Forms

• Anesthesia Patient Health Assessment (PDF)
• Sterilization Consent (PDF)
• General Surgical Consent (PDF)
• UWMC Postoperative Care Instructions  (PDF)
• Hysterectomy Consent (PDF)

Patient Education Handouts 

• Pelvic Anatomy
• Basal Body Temperature Chart (PDF)
• Dietary Bladder Irritants (PDF)
• Kegel Exercises (PDF)
• Voiding Diary (PDF)
• Bladder Retraining (PDF)
• Implanon Aftercare Instructions (PDF)
• Menstrual Record Chart (PDF)
• Vulvar Skin Care (PDF)
• Boric Acid for Recurrent Vaginal Yeast Infections (PDF)
• IUD Aftercare Instructions (PDF)
• Vitamin D Supplementation (PDF)

Family Planning Forms

• Miscarriage (PDF)
• Facts for Women: Termination of pregnancy, abortion, or miscarriage management (PDF)
• Medical Abortion Follow-up (PDF)
• What to Expect after First Trimester Surgical Abortion (PDF)
• Care After Your Dilation and Evacuation (D & E) (PDF)

Infertility and Reproductive Medicine Forms

• Infertility Questionnaire (PDF)
• Male Infertility Questionnaire (PDF)