Patient Forms

Patient forms may be filled out in two different ways. You may choose to either:

1. Log in and submit your forms online via our Patient Portal
   OR
2. Download and print the forms to bring with you to your appointment.

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Patient Portal

Our Patient Portal is a convenient way for you to complete many tasks including:

• Create a New Patient Account
• Request Appointments
• Request Prescription Refills
• View Lab Results
• Pay Your Bill
• Fill Out Registration Forms, Insurance Information, Update Demographics and Health History

Click here now to access our Patient Portal

(Wondering if forms can be electronic within the portal per Dr. Gelber’s prior email)

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Downloadable Forms

Patients are invited to download the following forms by clicking on the links below. Please bring the completed forms with you to your appointment.

General Forms

• Registration Form
• Notice of Privacy Practices
• Billing and Office Policies
• Sliding Fee Schedule
• Sliding Fee Application

New OB Patient Information

• New OB Questionnaire
• Prenatal Fee Contract
• Forms for Release or Obtain Medical Records
• Genetic Screening Options
• Complimentary DVD of 20 Week Ultrasound

New and Returning GYN Patient Information

• Annual Exam Questionnaire

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Patient Resources

Click here for information about Childbirth Education Classes at OBGYN & Midwifery Associates of Ithaca

(updated childbirth education form will be sent in another email, please link here)

Midwifery Care

• Midwives Alliance North America
• American College of Nurse-Midwives
• Midwifery & Women’s Health
• About Evidence Based Birth

Doula Support

• Ithaca Doula Collective
• DONA International

Breastfeeding Support

• Breastfeeding – The Bump
• La Leche League of New York
• NY Statewide Breastfeeding Coalition
• United States Breastfeeding

Postpartum Blues/Depression

• Postpartum Resource Center of New York
• The Postpartum Stress Center
• Postpartum Support International

General Patient Information

• ACOG Patient Page
• Childbirth Connection
• Spinning Babies
• NYS DOH Community, Family and Minority Health
• Women’s Health 

Delivery Site

• Cayuga Medical Center

Local Resources

• Cornell Cooperative Extension
• Tompkins County – WIC
• Ithaca Birth Guide

Pregnancy and Infant Loss Support:

• Share Pregnancy and Infant Loss Support
• AMEND – Aiding Mothers and Fathers Experiencing Neonatal Death