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RECORDS RELEASE FORM

If you need a Records Release Form please click here.


NEW PATIENTS

We respect your time and would like for you to spend the least amount of time in the office filling out forms. We would greatly appreciate if you would fill out the forms and print them before you come to the office to speed the registration process. 

CLICK HERE FOR NEW PATIENT REGISTRATION FORM 

CLICK HERE FOR MEDICAL HISTORY FORM 

Please arrive 15 minutes before your scheduled appointment and bring your insurance card. Thank You.

If you are NOT filling the forms ahead of time, please come to the office 20 minutes before your appointment as all the information will have to be manually entered into our system. Please also bring your insurance card.

Smiling Woman

Woman Smiling

ESTABLISHED PATIENTS

Even when you have already visited the Canton Women's Center in the past we would greatly appreciate if you would confirm that all the information we have is up to date. Please fill out the update form , print it, and bring it to your appointment to speed up the registration. Please arrive 10 minutes prior to your appointment and bring your insurance card.

CLICK HERE FOR ESTABLISHED PATIENT UPDATE FORM