Browse the tabs below to download the relevant forms and information ahead of your appointment.
If you are thinking of coming to Vital Health Endometriosis Center for treatment, simply begin the process by requesting a free record review and phone/Internet consultation with Dr. Cook. Or if you are within easy reach of our center, you may request an in-office consultation by calling our office at (408) 358-2511:
Before we can schedule for Dr. Cook to review your case or arrange an initial in-office consult, we will need you to print out and complete the five forms below and send them to us via mail, fax or email.
In addition to these five forms, please arrange to send us ONLY:
- Previous Abdominal Operative and Pathology Reports
- Color Surgical Photos if you have them
- Lab work completed in the last 18 months
New Patient Questionnaire
Medical Release Form
Medical Supplement Summary
Office Policy Form
* Please mail printed forms to 14830 Los Gatos Blvd., Suite 300, Los Gatos, CA 95032-2025 or fax the printed forms to (408) 358-1009, Attn: Michelle. Alternatively, you may scan and email documents to michelle@vitalhealth.com
The following documents provide essential information about how to reach our center for your first in-office appointment and your patient privacy:
HIPAA Privacy Information
Request for Special HIPAA Privacy
Additional forms as appropriate:
Phone/Internet Consult Information
Request for Form or Letter
VHI Medical Release to Another Doctor
Menopause Questionnaire
The following documents provide essential information in relation to your upcoming surgery. As soon as you schedule your surgery, please print out and read this information, referring back to it as your surgery date draws closer:
Things you should know about anesthesiology
Summary
Article Name
Patient Forms & Documents
Description
Fill out these patients forms & documents in preparation for your upcoming appointment, if you are a new patient, or have a surgery scheduled.