New Patient Forms & Instructions

Welcome to Maiden Lane Medical! Here is what you need to know before your first visit.

Please download and complete the following forms prior to your appointment. You may either bring your completed forms with you to our office at the time of your visit or fax them to us at (212) 532-4362.

 

Required Forms & Documents for All New Patients:

 

Required Forms for Patients with Pelvic Pain, Endometriosis, & Vaginal Pain:

**New patients suffering from chronic pelvic pain, please bring records from your current providers including the most recent progress note, operative and pathology reports, medication list, most recent ultrasound and /or MRI. Please limit records to approximately 10 pages.

 

Forms for Urodynamics & Urinary Complaints:

 

How to Prepare & What to Expect:

Upon your first visit, please bring as many records as you can gather. This may include office notes, lab studies, imaging (ultrasound, MRI), operative reports, and pathology reports.

You should expect to be in the office for approximately two hours for a very thorough initial evaluation. Please be patient while we work together to make a comprehensive, individualized plan for you.

If you are coming for minimally invasive gynecologic surgery, fibroids, abnormal bleeding, or general gynecology, please bring records that are relevant to your condition.

Please be aware there is a $40 charge for missed appointments or cancellations with less than 24 hours notice.

Services We offer and Conditions We Treat

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