Policies & Forms

Boulder Gynecology Policies & Forms

The following policies and forms will aid us in helping you with your gynecological needs in the most timely fashion.

Release of Medical Records.  If you would like your medical records sent to your primary care provider or another women’s health practitioner, please complete the Release of Medical Records form.  Please print it, complete and sign it, and then fax, email, or mail it back to us.  After we receive it, we can electronically fax them your records.  Provided there is no copying or mailing required, there will be no cost to do this.

Medical Insurances Accepted
We are contracted with the majority of medical insurances. A notable exception is Humana.  However, although we may have a contract with your insurance carrier, we may not be on your particular plan. It is your responsibility to check with your plan to determine if we are in your network.  If you fail to do so, you may be responsible for the full bill. You need to know the extent and limitations of your insurance coverage, deductible, and copay amounts. If you do not have insurance, we can provide a cash discount. Please call our office for an estimated cost for your office consultation.

Payment of Insurance Deductible and Outstanding Balances
You are responsible to pay your co-pay at the time services are provided. We will then bill your insurance. After we have received payment from your insurance company, we will bill you if there is any remaining balance owed by you.

We ask that you present a credit card at the front desk before your appointment. We will charge your credit card if we have not received payment of your balance 30 days after billing you. In situations where the amount exceeds $300, we will make a courtesy phone call to inform you of the exact amount. This policy ensures that we are paid in a timely manner and enables us to continue to provide medical care. Please be assured that your credit card information is kept in a secure, locked location, separate from your medical records.

Cancellation and No-Show Policies
You will be charged $50 if you fail to show up for your appointment or if you cancel your appointment with less than 24 hours’ notice. New patients who fail to keep two scheduled appointments will not be permitted to schedule further appointments with us.

Preventive Screening Policies
We appreciate the many philosophical approaches to health and agree that our society could benefit from a better integration of traditional western medicine and eastern healing practices. Having said that, we believe firmly in the value of established screening practices. You will be asked to sign a document, Boulder Gynecology Policies on Preventive Screening Tests when you initiate care through our office. Please review this document to ensure that you feel comfortable with it. If you do not agree with these policies, you should seek care elsewhere.

We will send you a letter with your Pap smear results or call you if the results require follow-up. However, if you have any biopsy in which tissue is removed (uterine or endometrial, cervical, vulvar or vaginal), our policy is to have you return for an in-person office appointment. We have established this policy for the following reasons: 1) to ensure we have received the results from the lab and communicate them to you, 2) to allow us the opportunity to discuss the implications of the results and options for further treatment if indicated, and 3) to permit a more sensitive discussion of the results in person in case a malignancy is discovered. We realize that there are times when the follow-up visit will be brief because the results are normal and no further treatment is needed, but we cannot predict when this may occur.

Late Policy
We make every effort to run on schedule and not keep you waiting. Occasionally this is unavoidable because of urgent or unscheduled medical problems. We ask you arrive on time. If you are more than 15 minutes late, we will attempt to fit you in later the same day. However, other patients scheduled after you who arrived on time will be seen first. If it is not possible to fit you in later, we will reschedule your appointment for another day.

After-Hours Care
We participate in a shared call schedule with other gynecologists for weekend and after hours care. If you have an urgent problem, a phone call to our office will refer you to the physician covering our practice. We ask that you restrict calls to urgent matters requiring prompt attention. Please anticipate your needs, and do not call after hours for refills of your regular medication(s).

As a courtesy to our patients, we provide our standard office forms online - select the button/link below. You can choose to come in to your appointment 15 minutes early to fill out these forms in-office, or you can fill out the patient forms online, print them at home, sign them, and bring them pre-filled when you arrive to check-in for your appointment.


Patient Forms

Call us (720) 382-2621 or email us at info@bouldergynecology.com.