Patient Intake

Thank you for your interest in the Umbrella Medical Clinic!

Please complete the following forms before arriving at your appointment.

Covid Screening Form

General Patient Intake Form

Specific Appointment Form – You Will Be Told Which Ones To Fill Out

1. Contraception Form
2. Emergency Contraception Form
3. HPV Virus Vaccine
4. IUD Consent Form
5. Mifegymiso Consent Form
6. Pap Test Form
7. Sexually Transmitted Infection (STI) Form

Our Staff Are Looking Forward to Assisting You!