New Patient Forms

Instructions:

  1. Click on the appropriate links below to download the forms.
  2. Print out and complete the forms.
  3. Please bring to your first appointment.
  4. Dr. Fujita's staff will review your information at your first visit.
  5. Please bring your picture ID, medical insurance card, and medical records that you may have.

PDF Forms Available for Download:

  1. Authorization for Use and Disclosure of Protected Health Information
  2. Medical History
  3. Obstetrics & Gynecology Registration Sheet

Additional Information

Notice of Privacy Practices

The above forms are available for download as PDF files. To open these files you must have Adobe Acrobat Reader installed on your computer. If you don't already have a copy, you can download it for free by clicking here.