Patient forms to fill out prior to office visit
As a new patient of Teverbaugh, Croland, and Mueller OBGYN & Associates, you may download and complete our new patient forms so that you may bring them with you to your first appointment. By completing the paperwork prior to your initial appointment, we can expedite your check-in and ensure that you have adequate time to complete your medical history information from the privacy and convenience of your home.
Completed forms may be faxed to 692-2446 or mailed to 8600 N. Rt 91, Suite 330 Peoria Il, 61615. You may also drop off any completed forms at our office during the hours of 8 a.m.-4:30p.m., Monday through Friday.
The Patient information, Gynecology Questionnaire and OB Questionnaire may be completed and submitted electronically.
The authorization to disclose information and financial policy are download and print only since they require an original signature. These two forms may be filled out and brought to your new patient appointment.
* Submitting prior to appointment via email:
Please download and save the below 
documents to your computer. Fill form fields, save document and email completed documents to obgynofpeoria@gmail.com prior to appointment. You can also print completed forms and fax them to 309-692-2446.
New Gynecology Patient
Patient registration (please submit prior to appointment)
Gynecology questionnaire (please submit prior to appointment)
Authorization to disclose information (download and print only)
Financial policy (download and print only)
New Obstetric Patient
Patient registration (please submit prior to appointment)
OB Questionnaire (please submit prior to appointment)
Gynecology questionnaire (please submit prior to appointment)
Authorization to disclose information (download and print only)
Financial policy (download and print only)
New NaProTechnology Patient
Patient registration (please submit prior to appointment)
Gynecology questionnaire (please submit prior to appointment)
NaPro questionnaire-Female (please submit prior to appointment)
NaPro questionnaire-Male (please submit prior to appointment)
Extras
Gynecology FAQs
OTC Medications (safe to take in pregnancy)
Records Release Form (Download and Print Only)
We ask that all new patients arrive 30 minutes prior to their appointment.
Upon arriving at our office, we will ask you to provide us with the preferred hospital for your insurance. We send labs, pap smears and biopsy specimens to OSF St. Francis, Methodist Medical Center and Proctor Hospital. If you do not know your preferred hospital, please call the customer service number on the back of your insurance card and request this information prior to your appointment.
If you have any questions you may submit them online ou call our office at (309) 692-2025 during the hours of 8 a.m. – 4 p.m., Monday through Friday.
