Patient Forms

Below are forms that can be filled out in advance of your visit. If you have been asked to fill out a form, please download it, print it out and provide all appropriate information as completely as possible. If you have additional questions or concerns, please feel free to contact us.

Patient Information Form

Patient Health and History Form

Patient Insurance and
Responsibilities Information

Medication List

Medical Information Release Form

HIPAA Notice of Privacy Practices

To learn more about downloading and uploading forms, click here.

 

How to Access the Patient Portal

To access our patient portal, please click on the link in the gray bar at the bottom of the page.

Once you click on the link below, you will be directed to the Patient Portal login page where you will be asked to enter your own username and password. Once you successfully log in, you will be directed to click on the "accept" button before accessing your chart. Clicking on the "accept" button means that you accept the terms of use and that you agree to comply with the requirements of the portal of Jeffrey M. Blake, M.D., Inc.

 

Patient Resources

Below you will find some valuable downloadable publications to help you understand some of the unique health issues women face and current treatments available. As always, if you have additional questions or concerns, please feel free to contact us.

 

PatientInfosmPatient Information

This helpful brochure provides general information about our practice, including, phylisophy, services offered, office locations, and contact information during regular office hours and after-hours.

HealthcareForWomensmHealthcare for Women

This helpful brochure explores some common issues related to women's health and new treatments available from Dr. Blake and his associates. Please feel free to download the brochure to your computer or stop by our office to pick up a copy to learn more about state-of-the-art healthcar for women. If you have questions or would like additional information, please contact us.
 

Bio-Identical Hormone Replacement

Hormone pellets have been used for many years to treat several medical conditions including ovarian and testicular failure. Very popular and approved for use in Europe, pellet therapy has yet to be approved by the FDA for treatment of low hormonal conditions in women. However, the branded Testipel (testosterone pellets) is currently approved by the FDA for use in men. Hundreds of medical studies demonstrate the efficacy and safety of pellets. The convenience and frequently superior results seen with pellet insertion has made their popularity rapidly grow over the past decade in treating ovarian failure/menopause and low testosterone. We are proud to be able to provide this alternative option for treatment. The following information will help answer your questions regarding hormonal pellet therapy for both men and women.

Pellet Thearapy FAQs for Women

Pellet Thearapy FAQs for Men

PrenatInstsm1Prenatal Instructions

This handout has been prepared by Dr. Blake and staff to assist you in the upcoming months of your pregnancy. Many odd and sometimes uncomfortable, as well as miraculous and exciting things will be happening from here on. Our feeling is that the more you know, the more you will appreciate and enjoy your pregnancy, and the less you will (hopefully) worry. Although everything cannot be covered in this handout, we have tried to include the more common and important issues you may encounter.

Please feel free to download the this information to your computer or stop by our office to pick up a copy. If you have additional questions, please feel free to contact us.

Discharge Instructions

Below are several informational handouts for our patients. Dr. Blake has prepared these documents to answer a lot of the questions you may have after common procedures. Please feel free to download the this information to your computer or stop by our office to pick up a copy. If you have additional questions, please feel free to contact us

Discharge Instructions for Gynecology Patients

Laparoscopy Discharge Instructions

Discharge Instructions for Laparoscopic Hysterectomy Patients

Post D&C/Hysteroscopy Instructions

EndoAbalationsm1About Endometrial Ablation

Endometrial ablation refers to any method by which the lining of the uterus (endometrium) is destroyed or removed in an effort to normalize or stop menstrual flow. There are multiple techniques available to accomplish this process. An ablation is performed when a woman’s periods are troublesome in either their flow and/or length. Commonly considered a “hysterectomy alternative”, the endo-metrial ablation has become a mainstay in the treatment of menstrual problems.

This helpful brochure was written by Dr. Blake to help women understand one of the newest techniques for EA, the HerOption® Cryotherapy Ablation system. Please feel free to download the brochure to your computer or stop by our office to pick up a copy to learn more about the benefits of this new treatment. If you have questions or would like additional information, please contact us.

EndoAblation2sm1aEndometrial Ablation - In-Depth

This more detailed description of Endometrial Ablation will help you understand the advantages of this alter-native to hysterectomy, learn more about how the procedures is performed and answer questions you may have about whether this option might be right for you.

Please feel free to download the this information to your computer or stop by our office to pick up a copy. If you have questions or would like additional information, please contact us.

HysterectomysmHysterectomy

Dr. Blake provides valuable information and answers to questions about one of the most common surgeries that concern women – hysterectomy.Learn exactly what is involved and why this surgery may be a necessary option.

Please feel free to download the this information to your computer or stop by our office to pick up a copy. If you have questions or would like additional information, please contact us.

UrinaryIncontsmUrinary Incontinence

Losing your urine is no laughing matter – unless you are laughing when it happens... then I guess it is. Seriously though, this is a common problem that many women experience at one time in their lives. Losing urine after child-birth or as you get older is not normal (despite what they say), and is not something that you should feel has to be tolerated. The good news is that most of the time it is completely treatable and new procedures make it much easier than it used to be.

In this helpful booklet Dr. Blake describes the causes of urinary incontinence and offers information on newest technologies available for successful treatment. Please feel free to download the booklet to your computer or stop by our office to pick up a copy. If you have questions or would like additional information, please contact us.
 

ThyroidTestsmUnderstanding Your Thyroid Testing

Dr. Blake provides helpful information that gives patients with a better understanding of Thyroid Testing and Trteatment. You'll gain a better understanding of factors that affect your thyroid health and various medical treatment options available.

Please feel free to download the this information to your computer or stop by our office to pick up a copy. If you have questions or would like additional information, please contact us

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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