Forms
Use the links below to access frequently used/requested forms.
Medical History Forms
- Adult Medical History Form - Female
Tell us about yourself - fill out this form before your visit and bring it with you. - Adult Medical History Form - Male
Tell us about yourself - fill out this form before your visit and bring it with you.
Medical Records Release Forms
- Authorization for Release of Information from Harvard Vanguard Medical Associates
Request that Harvard Vanguard release your medical record to another healthcare provider. - Authorization for Release of Information to Harvard Vanguard Medical Associates
Request that another healthcare provider release your medical information to Harvard Vanguard.
Radiology Films/Images Release Forms
- Authorization for Release of Radiology Films/Images
Request that Harvard Vanguard release your Radiology films/images to the another person/facility. - Authorization to Obtain Radiology Films/Images
Request that another healthcare provider release your Radiology films/images to Harvard Vanguard.
OB/GYN Health Questionnaires
- OB Health Questionnaire for Initial Visits
Health questionnaire for patients to complete prior to their initial OB visit. - GYN Health Questionnaire for Initial Visits
Health questionnaire for patients to complete prior to their initial GYN visit. - GYN Health Questionnaire for Annual Visits
Health questionnaire for patients to complete prior to their annual GYN visit.
Health Care Proxy
- Massachusetts Health Care Proxy
Do you need to name someone you know and trust to make health care decisions for you?
