Accessibility Tools


Pay Your Bill Online

Only for Patients of Independence Women’s Clinic

Please complete the following Patient Forms prior to your appointment:
These forms should be completed on-line and will be securely submitted to our office.

Patient Information FormPatient Information Form
Receipt of Privacy Notice secureReceipt of Privacy Notice
Medical Records ReleaseMedical Records Release
Medical Records ReleaseFinancial Policy

Please click on each form icon below to download an Adobe Reader® document. Print, complete and return each form at your first appointment. The Notice of Privacy Practices is for your information only.

Notice of
Privacy Practices




If you don’t have Adobe Reader on your computer, click here for a free download:Adobe Reader