{"id":2614,"date":"2021-12-10T12:19:25","date_gmt":"2021-12-10T12:19:25","guid":{"rendered":"https:\/\/www.toplinemd.com\/rebecca-stern-md\/?page_id=2614"},"modified":"2026-05-14T03:14:34","modified_gmt":"2026-05-14T03:14:34","slug":"forms","status":"publish","type":"page","link":"https:\/\/www.toplinemd.com\/rebecca-stern-md\/forms\/","title":{"rendered":"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-padding-top:60px;--awb-padding-bottom:60px;--awb-background-color:#a5b5d7;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:977.6px;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:15px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:15px;--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\"><h1 style=\"text-align: center;\">Forms<\/h1>\n<\/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-border-color:#dfe5e8;--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:3%;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:977.6px;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:15px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:15px;--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-image-element\" style=\"--awb-margin-bottom:10px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\"><img decoding=\"async\" width=\"2560\" height=\"1707\" title=\"forms image header (1)\" src=\"https:\/\/www.toplinemd.com\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/forms-image-header-1-scaled.jpg\" alt class=\"img-responsive wp-image-2620\" srcset=\"https:\/\/www.toplinemd.com\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/forms-image-header-1-200x133.jpg 200w, https:\/\/www.toplinemd.com\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/forms-image-header-1-400x267.jpg 400w, https:\/\/www.toplinemd.com\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/forms-image-header-1-600x400.jpg 600w, https:\/\/www.toplinemd.com\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/forms-image-header-1-800x533.jpg 800w, https:\/\/www.toplinemd.com\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/forms-image-header-1-1200x800.jpg 1200w, https:\/\/www.toplinemd.com\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/forms-image-header-1-scaled.jpg 2560w\" sizes=\"(max-width: 1024px) 100vw, (max-width: 640px) 100vw, 1200px\" \/><\/span><\/div><div class=\"fusion-text fusion-text-2\"><p>For your convenience, the following forms are available for download. You can print them at home and fill them out when it\u2019s convenient for you. This way you can attend your appointment free of distractions allowing you to focus on your visit.<\/p>\n<\/div><ul style=\"--awb-size:18px;--awb-iconcolor:#a5b5d7;--awb-divider-color:#e0e0e0;--awb-line-height:30.6px;--awb-icon-width:30.6px;--awb-icon-height:30.6px;--awb-icon-margin:12.6px;--awb-content-margin:43.2px;\" class=\"fusion-checklist fusion-checklist-1 fusion-checklist-default fusion-checklist-divider type-icons\"><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-file-alt fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/Health-History-Questionnaire.pdf\" target=\"_blank\" rel=\"noopener\">Health History Questionnaire<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-file-alt fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"https:\/\/www.toplinemd.com\/practice-terms-policies\/#npp\" target=\"_blank\" rel=\"noopener\">Privacy Practice<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-file-alt fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/Notice-of-Privacy-Practices-Acknowledgement.pdf\" target=\"_blank\" rel=\"noopener\">Notice of Privacy Practices Acknowledgement<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-file-alt fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/Patient-Information-Sheet.pdf\" target=\"_blank\" rel=\"noopener\">Patient Information Sheet<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-file-alt fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/Record-Release.pdf\" target=\"_blank\" rel=\"noopener\">Record Release<\/a><\/p>\n<\/div><\/li><\/ul><\/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\" style=\"--awb-border-sizes-top:1px;--awb-border-sizes-bottom:1px;--awb-border-color:#dfe5e8;--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:3%;--awb-background-color:#f5f9f9;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:977.6px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:15px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:15px;--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-3\"><h4 style=\"text-align: center;\">WHAT WE OFFER<\/h4>\n<h2 style=\"text-align: center;\">Services<\/h2>\n<\/div><ul class=\"service-box\">\n\n\t<li class=\"service\">\n\t\t<div class=\"service-bg\">\n\t\t\t<img decoding=\"async\" src=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/Aesthetics-image.jpg\" alt=\"Aesthetics\">\t\n\t\t<\/div>\n\t\t<a href=\"\/rebecca-stern-md\/aesthetics\/\">\n\t\t\t<h4>Aesthetics<\/h4>\n\t\t\t<button>more info <i class=\"fa fa-chevron-circle-right\"><\/i> <\/button>\n\t\t<\/a>\n\t<\/li>\n\n\t<li class=\"service\">\n\t\t<div class=\"service-bg\">\n\t\t\t<img decoding=\"async\" src=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/Robotic-Surgery-img.jpg\" alt=\"Robotic Surgery\">\t\n\t\t<\/div>\n\t\t<a href=\"\/rebecca-stern-md\/robotic-surgery\/\">\n\t\t\t<h4>Robotic Surgery<\/h4>\n\t\t\t<button>more info <i class=\"fa fa-chevron-circle-right\"><\/i> <\/button>\n\t\t<\/a>\n\t<\/li>\n\n\t<li class=\"service\">\n\t\t<div class=\"service-bg\">\n\t\t\t<img decoding=\"async\" src=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/Skin-Discoloration-img.jpg\" alt=\"Skin Discoloration\">\t\n\t\t<\/div>\n\t\t<a href=\"\/rebecca-stern-md\/skin-discoloration\/\">\n\t\t\t<h4>Skin Discoloration<\/h4>\n\t\t\t<button>more info <i class=\"fa fa-chevron-circle-right\"><\/i> <\/button>\n\t\t<\/a>\n\t<\/li>\n\n\t<li class=\"service\">\n\t\t<div class=\"service-bg\">\n\t\t\t<img decoding=\"async\" src=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/HGH-Gel-img.jpg\" alt=\"HGH Gel\">\t\n\t\t<\/div>\n\t\t<a href=\"https:\/\/www.toplinemd.com\/rebecca-stern-md\/birth-control-2\/prp-filler\/\">\n\t\t\t<h4>PRP Dermal Filler<\/h4>\n\t\t\t<button>more info <i class=\"https:\/\/www.toplinemd.com\/rebecca-stern-md\/birth-control-2\/prp-filler\/\"><\/i> <\/button>\n\t\t<\/a>\n\t<\/li>\n\n\t<li class=\"service\">\n\t\t<div class=\"service-bg\">\n\t\t\t<img decoding=\"async\" src=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/Skin-Tightening-img.jpg\" alt=\"Skin Tightening\">\t\n\t\t<\/div>\n\t\t<a href=\"\/rebecca-stern-md\/skin-tightening\/\">\n\t\t\t<h4>Skin Tightening<\/h4>\n\t\t\t<button>more info <i class=\"fa fa-chevron-circle-right\"><\/i> <\/button>\n\t\t<\/a>\n\t<\/li>\n\n\t<li class=\"service\">\n\t\t<div class=\"service-bg\">\n\t\t\t<img decoding=\"async\" src=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/Labiaplasty-img.jpg\" alt=\"Labiaplasty\">\t\n\t\t<\/div>\n\t\t<a href=\"\/rebecca-stern-md\/labiaplasty\/\">\n\t\t\t<h4>Labiaplasty<\/h4>\n\t\t\t<button>more info <i class=\"fa fa-chevron-circle-right\"><\/i> <\/button>\n\t\t<\/a>\n\t<\/li>\n\n\t<li class=\"service\">\n\t\t<div class=\"service-bg\">\n\t\t\t<img decoding=\"async\" src=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/ml-touch.jpg\" alt=\"MonaLisa Touch\">\t\n\t\t<\/div>\n\t\t<a href=\"\/rebecca-stern-md\/monalisa-touch\/\">\n\t\t\t<h4>MonaLisa Touch<\/h4>\n\t\t\t<button>more info <i class=\"fa fa-chevron-circle-right\"><\/i> <\/button>\n\t\t<\/a>\n\t<\/li>\n\n\t<li class=\"service\">\n\t\t<div class=\"service-bg\">\n\t\t\t<img decoding=\"async\" src=\"\/rebecca-stern-md\/wp-content\/uploads\/sites\/230\/2021\/12\/urinary-inc.jpg\" alt=\"Urinary Incontinence\">\t\n\t\t<\/div>\n\t\t<a href=\"\/rebecca-stern-md\/urinary-incontinence\/\">\n\t\t\t<h4>Urinary Incontinence<\/h4>\n\t\t\t<button>more info <i class=\"fa fa-chevron-circle-right\"><\/i> <\/button>\n\t\t<\/a>\n\t<\/li>\n\n<\/ul><\/div><\/div>\n<\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":13,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-2614","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 5.0.1.1 - aioseo.com -->\n\t<meta name=\"description\" content=\"On this page you can find all the forms you will need for our practice. Visit the page to find out more.\" \/>\n\t<meta name=\"robots\" content=\"max-image-preview:large\" \/>\n\t<link rel=\"canonical\" href=\"https:\/\/www.toplinemd.com\/rebecca-stern-md\/forms\/\" \/>\n\t<meta name=\"generator\" content=\"All in One SEO (AIOSEO) 5.0.1.1\" \/>\n\n\t\t<!-- Global site tag (gtag.js) - Google Analytics -->\n<script async src=\"https:\/\/www.googletagmanager.com\/gtag\/js?id=UA-55254803-10\"><\/script>\n<script>\n window.dataLayer = window.dataLayer || [];\n function gtag(){dataLayer.push(arguments);}\n gtag('js', new Date());\n\n gtag('config', 'UA-55254803-10');\n<\/script>\n\t\t<meta property=\"og:locale\" content=\"en_US\" \/>\n\t\t<meta property=\"og:site_name\" content=\"Stern Comprehensive Women&#039;s Healthcare |\" \/>\n\t\t<meta property=\"og:type\" content=\"article\" \/>\n\t\t<meta property=\"og:title\" content=\"Forms | Stern Comprehensive Women&#039;s Healthcare\" \/>\n\t\t<meta property=\"og:description\" content=\"On this page you can find all the forms you will need for our practice. 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