My Doctor Online The Permanente Medical Group
Are you having back pain with any of the following?
- Severe pain, weakness or tingling in your leg(s).
- Difficulty stopping urination or loss of control of bladder or bowels.
- Unexplained fever, nausea or vomiting.
- A history of cancer or unexplained weight loss.
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Mary Ann Bloyer, CNM
Obstetrics and Gynecology
Quick Links
- Genetics
- GSAA Certified Nurse Midwives
- Drugs and Lactation Database
- Cold, Flu and Cough
- Early Beginning Flyer
- Early Start Program
- Early Start Program (Spanish)
- Healthy Beginnings Pregnancy Online Newsletter
- Labor and Delivery Tour
- Mirena Implant
- Paragard Implants
- Center for Reproductive Health
- Prenatal Courses
- Laproscopic-Hysterectomy
- Bladder Control for Women
- Cervical Cancer Screening Saves Lives
- Mammograms Save Lives
- Prepare for Your Procedure - Emmi
- Health Guidelines for Adults
- Be Active! Fitness resources
- Understanding Infertility
- Fremont Prenatal Class Calendar
General References
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Forms
General OB-GYN Forms
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Birth Control Consent Forms
- If you’ve chosen a long-term or permanent method of birth control, you’ll be asked to fill out a consent form the day you begin this method of birth control. Consent forms are filled out in the office, but it can be useful to read through these forms in advance so you know what to expect.
- General Health and Wellness Questionnaires
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Questionnaires for Gynecological Surgery
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Urinary Incontinence Treatment Forms
- If you’re experiencing urinary incontinence, keep track of your symptoms and bring a record to your next visit. This will help us in determining the best course of treatment.
- Early Beginning Flyer
- Kick Count WorkSheet
- Newborn Information Form
- Patient Health Questionnaire (PHQ-9)
- Prenatal Questionnaire
- Labor & Delivery Pre-admission Worksheet
- Medical Release Form
- Medical Release Form (Chinese)
- Medical Release Form (Spanish)
Pregnancy and Childbirth Forms
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Prenatal Screening Forms and Questionnaires
- If you’ve chosen prenatal screening in your first or second trimester, please preview these forms before your visit.
- Prenatal Questionnaire
- Prenatal Questionnaire (Spanish)
- Prenatal Questionnaire (Chinese)
- Labor and Delivery Forms and Questionnaires