Vital Health Institute: Forms: Refill Request, Medical Release Form

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Vital Health Forms

– Additional Resources

For Physicians

– Physician Articles

– Surgery Photos

Forms for Prospective Patients
	Fill out and submit online: Request a Surgical Consult Review My Case Ask Dr. Cook
Forms for New Patients
	Fill out PDF form, print out, and mail/fax:* Patient Registration Form New Patient Questionnaire – Pelvic Pain Medical Release Form VHI Medical Release to Another Doctor Appointment Confirmation for Office Visit Office Policies HIPAA Privacy Information Print PDF form, write answers, and mail/fax:* General New Patient Questionnaire – No Pelvic Pain Print out: Directions to Vital Health Institute * Our mailing address is 15055 Los Gatos Blvd., Suite 250, Los Gatos, CA 95032-2025. Or you can fax the forms to us at (408) 358-1009, Attn: Michelle Waterstreet.
Forms for Surgery Patients
	Print out: Out of Area Surgery Timelines Herbs and Supplements to Avoid Prior to Surgery Things You Should Know About Anesthesiology What to Expect After Surgery Surgical Policies
Forms for Existing Patients
	Fill out and submit online: Prescription Refill Request

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The content contained in this web site is for informational use only and is not intended as medical advice. You should always seek the advice and care of your local physician. Information on this web site is also subject to change without notice and may include technical inaccuracies or typographical errors.

Vital Health Institute is an international treatment center specializing in endometriosis, chronic pelvic pain, and minimally invasive laparoscopic surgery.
Women travel from throughout the U.S., Canada and countries worldwide for treatment by Dr. Andrew Cook and his dedicated, professional staff.