Patient Forms
Please download and complete the forms below before your virtual visit. Once completed, email them to drkw@giftmehealthinternational.org.
- Authorized To Disclose Form
- Patient Rights and Responsibilities Statement Form
- Sexual Health Assessment Form
- Notice of Privacy Practice Form
- Patient Registration Form
- Female Symptom Checklist Form
- Male Symptom Checklist Form
Note: These forms are required for all new and returning patients prior to scheduling a virtual consultation.
