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eCare Patient Portal



9807 Bustleton Avenue
Philadelphia, PA 19115
Get Directions

Hours

Mon/Wed 9:00am – 9:00pm
Tuesday 8:30am – 9:00pm
Thursday 8:00am – 7:30pm
Friday 8:00am – 3:00pm
Saturday Ask for availability


1844 Street Road
Southampton, PA 18966
Get Directions

Hours
Monday 8:30am – 4:00pm
Tuesday 10:00am – 2:00pm
Thursday 9:00am – 3:00pm
Friday 9:00am – 2:00pm

PATIENT FORMS


Welcome to the Millennium OB/GYN family. In order to make your first appointment go as quickly and smoothly as possible, please print and complete the following forms and bring them to your appointment along with your insurance card, copay, a photo ID and medical records from your prior OB/GYN if you have them. If you’re a new patient, please arrive 15 minutes before your scheduled appointment time.

 

PDF TX-65Patient Information

 

PDF TX-65Authorization to Speak to Another Regarding Medical Care

 

PDF TX-65Consent for Financial Responsibility

 

PDF TX-65General Consent to Treatment

 

PDF TX-65Authorization for Access or Release of Protected Health Information

 

 

PDF TX-65Standing Consent To External Prescription History

 
 

Payment/copay is expected at the time of your appointment. We accept cash, check, VISA, MasterCard, American Express and Discover.

 

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icon-online

eCare Patient Portal

Get Directions

9807 Bustleton Avenue
Philadelphia, PA 19115

Hours

Mon/Wed 9:00am – 9:00pm
Tuesday 8:30am – 9:00pm
Thursday 8:00am – 7:30pm
Friday 8:00am – 3:00pm
Saturday Ask for availability