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Patient Forms & Documents

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:

Request a Free Record Review with Dr. Cook

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
Patient Registration Form
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:

Directions to Vital Health Endometriosis Center
HIPAA Privacy Information
Request for Special HIPAA Privacy

Additional forms as appropriate:

Confirmation of Appointment with Dr. Cook
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:

Herbs and supplements to avoid prior to surgery
Things you should know about anesthesiology