Patient Resources

Thank you for choosing LPW for your healthcare. We make every effort to be of service to you and make your visit as enjoyable as possible. To make things easier, we've provided a list of our policies, along with forms you may need to complete.

Please arrive 15 minutes prior to your scheduled appointment time to give us time to input or update your information. In consideration of our other patients, if you arrive 15 minutes past your appointment time you may be asked to reschedule.

Payments / Co-Payments

Payments and co-payments, if required by your health plan, are expected at the time of service.

Insurance

LPW accepts most insurance plans. Please have your insurance or Medicare card available at each visit.

Cancellation Policy

To help ensure that we are able to provide prompt, efficient service to our patients, please notify us of a cancellation at least 24 hours before your scheduled appointment. A cancellation fee will be charged for cancellations received less than 24 hours in advance.

Effective July 15, 2014 there is a $15 fee per form to complete FMLA or short term disability paperwork.

Minors: We require you have the ID of an adult responsible for your payment at the time of your visit.

New Patients


Before your first appointment, please download, print and complete the following forms.

Document Name PDF
LPW Personal Info Sheet   DOWNLOAD
Patient Registration Sheet   DOWNLOAD
LPW Privacy Notice (HIPPA)   DOWNLOAD
Financial Policy   DOWNLOAD
Credit Card Information   DOWNLOAD

What to Bring to Your First Appointment:
  • State Issued Photo ID
  • Insurance Information (if applicable)
  • Completed Forms (from above)
  • Medical History Chart from previous OB/GYN (if applicable)
  • If you are a minor we require the ID of the party responsible for payment

Releasing Records



Records Release Forms

Your medical records may be transferred from another doctor's office to ours. We can also release your medical records to be used by another physician. Whether you are transferring your records to our office or another doctor, please download and fill out the release form below.


  Authorization for Release of Information

  Releasing Records to Us

Please provide the form to your physician to transfer your records from their office to ours.

  Releasing Our Records to Another Doctor

Please fax or bring the form to our office to request your files.