• HOME
  • SERVICES
    • PREGNANCY
    • GYNECOLOGY
    • ROBOTIC SURGERY
  • PATIENT CENTER
    • NEW PATIENT FORMS
    • EDD/FMLA & DISABILITY PAPERWORK
    • PATIENT PORTAL
    • OFFICE POLICIES
    • FAQ’S
    • PATIENT INFO
  • ABOUT US
    • PROVIDERS
  • Contact

Redefining Personalized Care.

[email protected]
PATIENT PORTAL
Redlands OBGYNRedlands OBGYN
  • HOME
  • SERVICES
    • PREGNANCY
    • GYNECOLOGY
    • ROBOTIC SURGERY
  • PATIENT CENTER
    • NEW PATIENT FORMS
    • PATIENT PORTAL
    • EDD/FMLA & DISABILITY PAPERWORK
    • OFFICE POLICIES
    • ACCEPTED INSURANCES
    • FAQ’S
  • ABOUT US
    • PROVIDERS
  • CONTACT US

New Patient Forms

Welcome to Redlands OBGYN Associates! Thank you for choosing us for your care. We are honored to be part of your healthcare journey and look forward to meeting you. To make your first visit as smooth as possible, please complete the appropriate New Patient Forms prior to your appointment.

START HERE

STEP 1

Please select and fill out only one of the forms below based on the reason for your visit:
GYNECOLOGY PATIENTS
PREGNANCY (OBSTETRICS) PATIENTS
These secure forms can be completed digitally and submitted online.

STEP 2

Read Our Guest Policy:

To ensure a calm, safe, and private environment for all our patients, children are not permitted in the clinic. We kindly ask that you arrange childcare prior to your visit.

For our pregnant patients, you are welcome to bring one guest to your appointment. However, your guest will need to wait outside the clinic until you are called in and roomed by our staff. This helps us maintain patient privacy and reduce crowding in our waiting area.

We appreciate your understanding and cooperation as we work to provide the best care experience for everyone.

EXPLORE OFFICE POLICIES

Hospital-Related Forms

REDLANDS COMMUNITY HOSPITAL PRE-REGISTRATION FORM

Office Forms

If you are transferring care from another doctor or facility, or if you have previous medical records that need to be reviewed by Dr. Hage, please complete the form below:
RECORDS RELEASE FORM
WELCOME LETTER (OBSTETRICS PATIENTS)
MEDICAL HISTORY FORM

Disability & Maternity Leave Forms

If you need paperwork for disability leave due to pregnancy or surgery, please complete the following form:
MATERNITY/DISABILITY REQUEST FORM
For additional information on State Disability Insurance (SDI), Paid Family Leave (PFL), or Family Medical Leave (FMLA), please visit the California Employment Development Department (EDD).

NEED HELP?

If you have any trouble accessing or submitting your forms, feel free to call our office and we’ll be happy to assist you.

📞 (909) 748 – 6065
📍 255 Terracina Blvd, Suite 202, Redlands CA 92373
🕒 M-F, from 8am to 5pm

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ABOUT US

We are committed to providing you with the best women’s healthcare available. We address women’s unique concerns by providing the most up-to-date, accurate information about women’s health and we are here to answer all your questions!

Credentials:
Samir E. Hage, D.O. 20A7233 Doctor of Osteopathic Medicine (D.O.) Western University of Health Sciences 1997

FIND US HERE

Dr. Samir Hage
REDLANDS OBGYN

Address

255 Terracina Blvd Suite 202,
Redlands CA 92373

CONTACT US

Main Office: 909.748.6065

Fax Number: 909.748.6095

Email Address: [email protected]

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