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Ob-Gyn Patient Forms

These forms are for the Luminis Health Ob-Gyn locations in Annapolis, Kent Island, Pasadena and Waugh Chapel

Check with your Luminis Health Ob-Gyn office or your MyChart profile to determine the forms that they may require.

Patient Forms

Forms must be completed online or faxed to our preregistration department at (667) 204-7241 at least 72 business hours prior to your visit or your appointment(s) will be cancelled.

If you need to submit medical records prior to your appointment, please send all medical records to [email protected] or fax records to 667-204-7229.

New GYN Patients

(New to our practice or not seen in three or more years)

If you are being referred to us by another physician, please bring your referral form, if applicable, and any lab results that are relative to your visit with us. Be prepared to give us the name, address and phone number of your primary care physician.

New Prenatal Patient Packet

(New to our practice, have not been seen in over three years, or new pregnancy)

We will need to register your care with your insurance company, so please remember to fax your forms, as well as a copy of your insurance card at least 72 business hours prior to your initial visit or your appointment(s) will be cancelled. Please make every effort to obtain a copy of your prior records before your visit.  A copy of our record request form can be found at the bottom of this page.

Transferring from another OB? We will need your prenatal records before we can make you an appointment for your initial visit with our practice.   Please complete the New Patient OB Transfer Checklist along with the Consent to Release Medical Records to Luminis Health OB-GYN – Annapolis form, and forward those to your previous OB-GYN. Once we receive your records we can begin your pre-registration process.

Records Request Form

In an effort for our providers to have your complete medical history at your visit, we ask that you obtain these records from your prior physician’s office. Please download, print, and complete the form below to obtain your records from your previous healthcare provider.

If you would like a copy of those records, please have records sent directly to you so you can make a copy for yourself, prior to bringing them to our office. Once we receive your records, we will not return them to you. There is a place on the form to check ‘send records to patient’. Keep in mind that some offices take up to one month to process your request for records. Records should be mailed to Luminis Health OB-GYN – Annapolis office or hand-carried to your appointment.

If you would like a copy of your records from our practice, please print, complete and fax the following form.

Printable Forms

To view the forms listed below, you will need Adobe ReaderPlease download and print one set of forms only. Do not complete forms for two different appointment types. Click on the link that describes your appointment type.