{"id":1530,"date":"2023-07-13T12:06:41","date_gmt":"2023-07-13T12:06:41","guid":{"rendered":"https:\/\/www.toplinemd.com\/palm-beach-womens-care\/?page_id=1530"},"modified":"2025-09-17T15:34:24","modified_gmt":"2025-09-17T15:34:24","slug":"patients-forms","status":"publish","type":"page","link":"https:\/\/www.toplinemd.com\/palm-beach-womens-care\/forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-background-color:#7375a3;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1019.2px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-title-center fusion-title-text fusion-title-size-one\" style=\"--awb-margin-top:40px;--awb-margin-bottom:20px;\"><div class=\"title-sep-container title-sep-container-left\"><div class=\"title-sep sep- sep-solid\" style=\"border-color:#e0dede;\"><\/div><\/div><span class=\"awb-title-spacer\"><\/span><h1 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:45;line-height:1.2;\">Patient Forms<\/h1><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep- sep-solid\" style=\"border-color:#e0dede;\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-background-repeat:repeat;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:3%;--awb-padding-bottom:4%;--awb-background-color:#ffffff;--awb-flex-wrap:wrap;\" id=\"services\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"max-width:1019.2px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><p style=\"text-align: center;\">Please print these registration forms, fill them out and bring them to your office visit.<br \/>\nYou can also fax them to us so we can expedite your visit.<\/p>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat button-medium button-custom fusion-button-default button-1 fusion-button-span-yes \" style=\"--button_accent_color:#ffffff;--button_accent_hover_color:#ffffff;--button_border_hover_color:#ffffff;--button_gradient_top_color:#7375a3;--button_gradient_bottom_color:#7375a3;--button_gradient_top_color_hover:#6163a3;--button_gradient_bottom_color_hover:#6163a3;--button_text_transform:uppercase;\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"\/palm-beach-womens-care\/wp-content\/uploads\/sites\/274\/2023\/07\/Patient-registration-form-new.pdf\"><span class=\"fusion-button-icon-divider button-icon-divider-left\"><i class=\"fa-file-pdf fas awb-button__icon awb-button__icon--default\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-button-text awb-button__text awb-button__text--default fusion-button-text-left\">Patient registration form<\/span><\/a><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat button-large button-custom fusion-button-default button-2 fusion-button-span-yes \" style=\"--button_accent_color:#ffffff;--button_accent_hover_color:#ffffff;--button_border_hover_color:#ffffff;--button_gradient_top_color:#7375a3;--button_gradient_bottom_color:#7375a3;--button_gradient_top_color_hover:#6163a3;--button_gradient_bottom_color_hover:#6163a3;--button_text_transform:uppercase;\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"\/palm-beach-womens-care\/wp-content\/uploads\/sites\/274\/2023\/07\/Financial-policy-new.pdf\"><span class=\"fusion-button-icon-divider button-icon-divider-left\"><i class=\"fa-file-pdf fas awb-button__icon awb-button__icon--default\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-button-text awb-button__text awb-button__text--default fusion-button-text-left\">Financial policy<\/span><\/a><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat button-large button-custom fusion-button-default button-3 fusion-button-span-yes \" style=\"--button_accent_color:#ffffff;--button_accent_hover_color:#ffffff;--button_border_hover_color:#ffffff;--button_gradient_top_color:#7375a3;--button_gradient_bottom_color:#7375a3;--button_gradient_top_color_hover:#6163a3;--button_gradient_bottom_color_hover:#6163a3;--button_text_transform:uppercase;\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"\/palm-beach-womens-care\/wp-content\/uploads\/sites\/274\/2023\/07\/Arbitration-form-new.pdf\"><span class=\"fusion-button-icon-divider button-icon-divider-left\"><i class=\"fa-file-pdf fas awb-button__icon awb-button__icon--default\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-button-text awb-button__text awb-button__text--default fusion-button-text-left\">Arbitration form<\/span><\/a><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat button-large button-custom fusion-button-default button-4 fusion-button-span-yes \" style=\"--button_accent_color:#ffffff;--button_accent_hover_color:#ffffff;--button_border_hover_color:#ffffff;--button_gradient_top_color:#7375a3;--button_gradient_bottom_color:#7375a3;--button_gradient_top_color_hover:#6163a3;--button_gradient_bottom_color_hover:#6163a3;--button_text_transform:uppercase;\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"\/palm-beach-womens-care\/wp-content\/uploads\/sites\/274\/2023\/07\/Pelvic-exam-form-new.pdf\"><span class=\"fusion-button-icon-divider button-icon-divider-left\"><i class=\"fa-file-pdf fas awb-button__icon awb-button__icon--default\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-button-text awb-button__text awb-button__text--default fusion-button-text-left\">Pelvic exam form<\/span><\/a><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-6 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat button-large button-custom fusion-button-default button-5 fusion-button-span-yes \" style=\"--button_accent_color:#ffffff;--button_accent_hover_color:#ffffff;--button_border_hover_color:#ffffff;--button_gradient_top_color:#7375a3;--button_gradient_bottom_color:#7375a3;--button_gradient_top_color_hover:#6163a3;--button_gradient_bottom_color_hover:#6163a3;--button_text_transform:uppercase;\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"\/palm-beach-womens-care\/wp-content\/uploads\/sites\/274\/2023\/07\/Acknowledgement-and-Authorization-Form-new.pdf\"><span class=\"fusion-button-icon-divider button-icon-divider-left\"><i class=\"fa-file-pdf fas awb-button__icon awb-button__icon--default\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-button-text awb-button__text awb-button__text--default fusion-button-text-left\">Acknowledgement and Authorization<\/span><\/a><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-animated\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:40px;--awb-padding-bottom:40px;--awb-background-color:#fcf5f5;--awb-flex-wrap:wrap;\" data-animationType=\"zoomIn\" data-animationDuration=\"0.7\" data-animationOffset=\"top-into-view\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1019.2px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-7 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:40px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-2 fusion-title-center fusion-title-text fusion-title-size-three\" style=\"--awb-text-color:#666666;--awb-margin-bottom:20px;--awb-font-size:24px;\"><div class=\"title-sep-container title-sep-container-left\"><div class=\"title-sep sep- sep-solid\" style=\"border-color:#e0dede;\"><\/div><\/div><span class=\"awb-title-spacer\"><\/span><h3 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;font-size:1em;--fontSize:24;--minFontSize:24;line-height:;\">Our Commitment to You<\/h3><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep- sep-solid\" style=\"border-color:#e0dede;\"><\/div><\/div><\/div><div class=\"fusion-text fusion-text-2\"><p style=\"text-align: center;\">We can handle any women\u2019s health issue and if we can\u2019t, Dr. Sacks will bring in specialists to assist him as needed. Whenever you visit our office, you won\u2019t be disappointed with our service or results. Call us today and get the personal treatment you always wanted but won\u2019t likely find anywhere but Palm Beach Women\u2019s Care. Call us today for an appointment at <a href=\"tel:+15612281330\">561-228-1330.<\/a><\/p>\n<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling padding-wrapper-responsive\" style=\"--awb-border-sizes-top:0px;--awb-border-sizes-bottom:0px;--awb-border-sizes-left:0px;--awb-border-sizes-right:0px;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:46px;--awb-padding-bottom:45px;--awb-background-color:#7375a3;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-8 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last fusion-column-no-min-height\" style=\"--awb-bg-blend:overlay;--awb-bg-size:cover;--awb-margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\"><div class=\"fusion-title title fusion-title-3 fusion-title-center fusion-title-text fusion-title-size-two\" style=\"--awb-text-color:#ffffff;--awb-margin-bottom:30px;\"><div class=\"title-sep-container title-sep-container-left\"><div class=\"title-sep sep- sep-solid\" style=\"border-color:#e0dede;\"><\/div><\/div><span class=\"awb-title-spacer\"><\/span><h2 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:40;line-height:;\">Request an Appointment<\/h2><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep- sep-solid\" style=\"border-color:#e0dede;\"><\/div><\/div><\/div><div class=\"fusion-aligncenter\"><a class=\"fusion-button button-flat button-large button-custom fusion-button-default button-6 fusion-button-default-span \" style=\"--button_accent_color:#ffffff;--button_accent_hover_color:#ffffff;--button_border_hover_color:#ffffff;--button_border_width-top:2px;--button_border_width-right:2px;--button_border_width-bottom:2px;--button_border_width-left:2px;--button_gradient_top_color:#7375a3;--button_gradient_bottom_color:#7375a3;--button_gradient_top_color_hover:#6163a3;--button_gradient_bottom_color_hover:#6163a3;--button_text_transform:uppercase;\" target=\"_self\" href=\"tel:+15612281330\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Call Now<\/span><\/a><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":13,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"100-width.php","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-1530","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.toplinemd.com\/palm-beach-womens-care\/wp-json\/wp\/v2\/pages\/1530","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.toplinemd.com\/palm-beach-womens-care\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.toplinemd.com\/palm-beach-womens-care\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/palm-beach-womens-care\/wp-json\/wp\/v2\/users\/13"}],"replies":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/palm-beach-womens-care\/wp-json\/wp\/v2\/comments?post=1530"}],"version-history":[{"count":0,"href":"https:\/\/www.toplinemd.com\/palm-beach-womens-care\/wp-json\/wp\/v2\/pages\/1530\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.toplinemd.com\/palm-beach-womens-care\/wp-json\/wp\/v2\/media?parent=1530"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}