Patient Information and Forms
Pre-Visit Information
- If you are a new patient please print out: financial policy and the patient medical questionnaire.
- If you are an established gynecological patient please print out the financial policy and the gyn form.
- If you are an infertility patient please print and fill out the infertility questionnaire.
- If you are a mental health patient please sign our contract and fill out the intake form prior to your visit.
Release of Health Information
- If you are our patient and would like to request your medical records, please click on the link below to complete your request for medical records. You will be required to provide a valid email address and a government-issued ID.
- If you are an attorney, insurance company, or any other entity requesting records from our facility, please click on the link below to upload your request along with the patient's authorization.
When will my online medical record request be ready?
Your records will be ready in 3-5 business days from the receipt of your electronic request.
How do I check the status of my request?
How do I pay for my records and/or radiology images?
How do I contact Customer Service?
- You may call: 858-244-1811
- Or Contact Support for live chat: https://hds.sharecare.com/contact-us/
FMLA/Disability Submission for Patients and Requesters
What is Sharecare, and what exactly do they do?
Sharecare is a health information management company contracted with Manchester OB/GYN Associates to provide services, including the completion of Disability and FMLA form paperwork.
How do I submit my FMLA or Disability paperwork?
• Log into portal
• Return the form to the practice
• Fax form to (603) 622-8677
Is there a fee to have my forms completed?
Yes, there is a pre-payment fee of $35 for the first form plus any applicable sales tax.
If I need another form completed to continue my disability claim, will I have to make another payment?
Yes, a pre-payment fee of $35 per form for each consecutive or subsequent FMLA or Disability form regarding the same qualifying condition and claim.
How can I pay for my forms?
Pay Online:
• Suppose you have provided a valid email address on your authorization form. In that case, you will receive an email notification with a payment link that will direct you to pay on the Sharecare payment portal website.
• If you did not provide an email address on your authorization form or cannot locate the email notification, you could pay online. You will need your Request ID to make the payment.
Pay by Phone:
• Contact the Sharecare Forms Department at 866-273-4039. We like to make it as easy and convenient as possible for you. We accept all major credit cards. We do not accept HSA cards as a payment method.
What is a Request ID?
A Request ID is a unique ID specific to the individual patient and form being completed. Sharecare assigns the ID, and if you are unable to locate it, you can contact Sharecare for assistance at 866- 273-4039.
Do I need to sign an authorization form even if I want the form sent back to me?
Yes, we would like all the patients to fill out a Request for Form Completion document when requesting a form to be completed. This document provides the team with information on where and how to send the form. Also, if a disability insurance company calls, we cannot give any information without consent, thus delaying your claim with your disability company. In addition, this document asks for the patient to identify the treating provider, injury/problem date, and last day worked, which will aid in completing your form.
I do not use email or know my Request ID number. How can I get status updates on the completion of my form?
You can contact the Sharecare Forms Department at 866-273-4039 for the status of your form, as well as the Request ID number associated with your form.
I need to update the information on my FMLA or Disability paperwork. What do I need to do?
We understand that FMLA forms, as well as disability determinations, may require an update of your medical information from your recent doctors' visit. You will need to re-submit the new paperwork to Manchester OB/GYN Associates for Sharecare to complete in such cases. There will be a fee of $35.00 required for any updates requested.
When will I receive my completed forms?
Please allow 48 hours for Sharecare to receive your form from the time you submit it to Manchester OB/GYN Associates. Once payment is received, it may take up to 5-7 business days to complete the forms. It is imperative to submit all information and make the pre- payment as soon as possible; failure to do so will delay the process.
I submitted my paperwork but no longer need it to be completed. How can I cancel it?
You can contact the Sharecare Forms Department at 866-273-4039 for assistance.
I still have questions?
Please reach out to our team at Sharecare, and we are happy to discuss any questions you might have. Contact us at 866-273-4039.
When will I receive my completed forms?
Please allow 48 hours for Sharecare to receive your form from the time you submit it to Manchester OB/GYN Associates. Once payment is received, it may take up to 5-7 business days to complete the forms. It is imperative to submit all information and make the pre- payment as soon as possible; failure to do so will delay the process.
Office Policies
- Arrival Policy: We ask patients to arrive 10-15 minutes prior to the scheduled appointment time. This allows us to check you into the system and verify your information prior to your appointment with the provider.
- Late Policy: If you arrive more than 10 minutes late for your appointment there is a possibility your appointment may be rescheduled. This will be done in order to keep the appointments following running on time.
- No Show Policy: Our office requires a 24-hour notice to cancel or reschedule an appointment. At Manchester OB/GYN Associates, we make every effort to schedule your appointment in a timely fashion, while ensuring the appointment length allows time for you to discuss your medical concerns with your provider. A last-minute cancellation or missed appointment will not only delay your care but also prevents us from rescheduling another patient who could have been seen at that time. We do understand that sometimes unforeseen emergency situations arise; however, we ask that you provide us with the courtesy of canceling or rescheduling your appointment at least 24 hours prior to your scheduled appointment. Please be aware that we do charge $50 for each appointment that is missed or rescheduled with less than 24 hours notice. If you have more than two last-minute rescheduled or missed appointments you may be discharged from our practice.
Epic Electronic Medical Records
Proud Member of the U.S. Women's Health Alliance
Humana/Tricare
Laboratory Services
