Patient resources
Forms, handouts and guides for your care
Fill in your forms before your first visit so your appointment can focus on you. Below are the forms you need, and the handouts we give patients for each kind of care.
Step 1 · New patients
Which forms do I need?
Find the kind of visit you are booking. Download each form, fill it in, then send it to us.
- Obstetrics
Pregnancy (OB)
You’ll need:
- Gynecology
Gynecology (GYN)
You’ll need:
- Hormone therapy
Hormone therapy (HRT)
You’ll need:
- Gynecology (GYN) registration forms
- Hormone therapy intake & consent Spanish version (Español)
- Women’s health questionnaire
The hormone therapy form is also available in Spanish.
- Wellness
Wellness treatments
You’ll need:
- Pregnancy (OB) registration forms
- or Gynecology (GYN) registration forms
- Women’s health questionnaire
Choose the OB or the GYN registration forms, whichever matches the care you receive with us.
Step 2 · Send them back
Email your completed forms
Save the filled-in PDF and attach it to an email to admin@moolaobgyn.com. Please put your full name in the subject line. You can also print the forms and bring them to your visit.
Tip
Forms marked “Fill on screen”
Open them in Adobe Acrobat Reader (free), Preview on a Mac, or Chrome, type your answers and save. On a phone, Acrobat Reader works best.
Obstetrics & Gynecology
Pregnancy and women’s health
Registration forms, the information sheets we give every pregnant patient, and plain-language guides to common conditions and procedures.
Forms
- Pregnancy (OB) registration forms Registration, insurance and pregnancy history. Fill on screen PDF · 5 pages · 495 KB
- Gynecology (GYN) registration forms Registration, insurance, consents and health history. Fill on screen PDF · 4 pages · 436 KB
- Women’s health questionnaire For every new patient. A symptom checklist: energy, sleep, mood, hot flashes and more. Fill on screen PDF · 1 page · 353 KB
Pregnancy handouts
- Welcome letter for pregnant patients What to expect from your prenatal care, and how to reach us after hours. Read & keep PDF · 1 page · 167 KB
- Danger signs in pregnancy Warning signs that mean you should call the office or seek care right away. Read & keep PDF · 1 page · 201 KB
- Medications during pregnancy Remedies and over-the-counter medicines for common pregnancy complaints. Read & keep PDF · 1 page · 260 KB
- Body changes when pregnant Common, normal changes you may notice as your pregnancy progresses. Read & keep PDF · 1 page · 87 KB
- Postpartum recovery & feminine wellness Changes after childbirth, and the non-invasive treatments we offer to help you recover. Read & keep PDF · 2 pages · 222 KB
Hormone Therapy
Hormone replacement therapy
Everything you need before your first hormone therapy visit. The intake and consent form is in English and Spanish.
Forms
- Gynecology (GYN) registration forms Registration, insurance, consents and health history. Fill on screen PDF · 4 pages · 436 KB
- Hormone therapy intake & consent Your health history and your consent for hormone replacement therapy. Fill on screen PDF · 6 pages · 467 KB
- Hormone therapy intake & consent (Spanish) The same form in Spanish: Terapia de reemplazo hormonal. Fill on screen Español PDF · 6 pages · 712 KB
- Women’s health questionnaire For every new patient. A symptom checklist: energy, sleep, mood, hot flashes and more. Fill on screen PDF · 1 page · 353 KB
Learn more
Wellness
Wellness treatments
A brochure for each treatment we offer, the Exomind consent form in English and Spanish, and what to do before and after your sessions.
Forms
- Pregnancy (OB) registration forms Registration, insurance and pregnancy history. Fill on screen PDF · 5 pages · 495 KB
- Gynecology (GYN) registration forms Registration, insurance, consents and health history. Fill on screen PDF · 4 pages · 436 KB
- Women’s health questionnaire For every new patient. A symptom checklist: energy, sleep, mood, hot flashes and more. Fill on screen PDF · 1 page · 353 KB
Treatment brochures
- Emsella brochure The chair treatment for bladder control and pelvic floor strength. Read & keep PDF · 2 pages · 858 KB
- Emfemme 360 brochure A non-invasive feminine wellness treatment. Read & keep PDF · 2 pages · 1.1 MB
- Emsculpt NEO brochure Body contouring that works on muscle and fat. Read & keep PDF · 1 page · 1.2 MB
- Exomind brochure Non-invasive brain stimulation for mental well-being. Read & keep PDF · 2 pages · 2.2 MB
Exomind consent form
For everyone
Privacy, records and insurance
Your rights over your health information, and how billing works.
- Notice of Privacy Practices (HIPAA) How your medical information may be used and shared, and your rights over it. Read the notice
- Records release authorization Please contact our office. (951) 732-7834
- Insurance, payment & billing At the office of Sudha Moola, MD, we accept most major insurance plans. Please contact your insurance company, or call our office, to confirm your coverage.