Dr. David B. Schwartz, MD, Obstetrics & Gynecology 513-241-4223
 FORMS
In order to save precious time at your office visit, all the forms that we use in our office are available on this website. Simply click the form name to view the webpage form and then choose one of the following two methods for filling out and printing your form:

OPTION 1: First click the PRINT FORM button and then hand-write out your information or
OPTION 2: First type your information directly on the webpage and then click the PRINT FORM button

Please bring these forms with you when you come to the office for your visit.

New Patient Information (133kb .pdf file)
Every new patient needs to fill out this form and update it yearly to keep it current.
INSTRUCTIONS: Clicking this link will pop a new window and load the PDF file. At the bottom of this PDF file, there is a floating gray tool bar (you might have to hold your mouse at the bottom to make it display) There are 4 buttons: Zoom out, Zoom in, Open PDF in preview, and Save PDF to download folder. Click Open PDF in preview to show the fillable form fields as shaded and to enable the print form link.

Obstetrical Visit (3 pages)
If this is your first obstetrical visit, please fill out as much of this form as you can.

PapSure and HPV Testing Permissions (1 page)

Notice of Privacy Practices ( 340kb .pdf file)
This is a downloadable .pdf file that every patient needs to read then you need to download and sign the Written Acknowledgement below.

Written Acknowledgement (1 page)
Every patient needs to read the Notice of Privacy Practices and then sign the Written Acknowledgement.

Gynecology Visit (3 pages)
If your visit is for gynecologic care, please fill out as much of this form as you can.

 
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