Welcome to our new provider, LINDSEY CIESLAK, APRN! Lindsey is immediately available to see patients for all gynecologic and urogynecologic issues. Scroll down and click on her photo to learn more, or book an appointment online today!

Patient Forms

Advanced Urogynecology Contents Patient Resources New Patient Forms

 

New Patient Demographics

This is the form for NEW PATIENTS DEMOGRAPHICS. Please download, complete, and bring it with you to your first visit. 

 

Medical History Form

This is the form for NEW PATIENTS' MEDICAL HISTORY. Please download, complete, and bring it with you to your first visit. 


Prolapse and Incontinence Forms

These forms are for patients who feel they may have prolapse or loss of urine and/or stool.  Please download, complete, and bring them with you to your first visit.

Patient Portal

We are pleased to provide patients with secure, 24/7 access to their health records through the Patient Portal. Patients can safely and easily:

  • Request prescription refills
  • Update insurance/demographic information
  • Review financial statements/make secure payments
  • View lab and test results
  • Access relevant health education materials  

Patient Portal Login

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We accept many insurance plans. For questions about insurance, please contact our office.

Aetna
Blue Cross Blue Shield
Cigna
Humana
Medicare
United Healthcare
WellCare
View full list of companies
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Advanced Urogynecology
260 Lookout Place
Suite 201
Maitland, FL 32751