Well Woman Exam Consent

Aurora Gonzalez, M.D. & Associates puts the patient first by providing outstanding service to each and every patient, each and every visit. In keeping with our practice of educating patients, we would like to inform you that if you are scheduled for a well woman exam this will include a Vaginal and Breast exam along with Pap smear when recommended by Provider.

It’s important to remember that anything your provider treats as a problem during your well woman exam changes the visit to a problem-oriented one. Any test performed that doesn’t relate to the well woman exam will be applied to your copay/deductible and any costs associated with the additional services billed to insurance.

If there are complicated medical issues that you would like to discuss with your physician that fall outside of a well woman exam, you can be scheduled for a separate appointment at another date/time where the provider can address these concerns. If your problem is emergent, we will address the problem today but will be required to reschedule the annual well woman exam.

If for any reason a problem visit is handled on the same day as annual visit, the insurance will be billed for each service separately. For example: Fasting Labs and Vaginal/Bladder infection lab testing may or may not be covered as wellness benefits.

Here is a list of issues commonly discussed at a well woman exam:

• Refilling your birth control prescription

• Refilling your hormone prescription

• Testing for sexually transmitted infections

If you have any questions or concerns regarding this policy, please feel free to discuss with our staff.

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