Clinic Forms

Moreland OB-GYN clinic interior
Below are links to important medical forms. They are PDF files that will open in a new browser window. Adobe Reader is required to view files. Download the latest version of Adobe Reader here.

Patient History
Instructions for Release of Information
Authorization to Release Protected Health Information:
This is a two page document. You must print or download both pages.     Page 1
Page 2
Authorization for Confidential Communication
General Consent for Admission/Treatment
Family Medical Leave (FMLA) and Disbililty Forms
Pregnancy Questionnaire
Cuestionairio De Embrazo
Menstrual Calendar
Are you Getting Enough Calcium?
LEEP Consent Form
Bone Mineral Density Test Patient Questionnaire

Contact Us

Phone: 262-544-4411
Fax: 262-650-3856

Moreland OB-GYN Associates, S.C. now offers nine locations to serve your needs. Visit us in Waukesha, Mukwonago, Muskego, Sussex, Brookfield & Hartland.

Moreland OB/GYN-Lake Country offers three locations in Delafield, Oconomowoc & Watertown.

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We understand the importance of women's sexual health and provide a safe, private environment. Click here to view products from Wisconsin's OB-GYN Specialists.