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Preparing for Your Visit to Ventura County Obstetrics & Gynecology

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.

Download Patient Forms

Please download and print the packet below that pertains to your appointment.

Important notes:

Please do not print the forms double sided.

Please only use BLACK or BLUE ink to fill out the forms. 

Other Forms

Effective June 1, 2025, CMHC will become the custodian of our medical records.  They will be made available to Dr. Gustafson and Ms. Margolis at the time of your appointment at the CFH.  We will be happy to forward your medical records to a physician of your choice prior to June 1st.   We will require a medical release form that can be obtained on our website vtaobgyn.com or in office.  The records will be available within 10 business days.

If you would like a copy of your medical records, we will supply one copy free of charge one time.  As we have paper charts if you have a long history with us, only pertinent records will be copied (most recent office visits, surgical operative notes, pathology, abnormal history, etc).    Quest lab, CMH and Rolling Oaks all have patient portals available to obtain their records as well (paps, mammograms, lab results).

If you would like a copy of your medical records after June 1st, you can request a copy in person, mail, fax, or email once you have downloaded the appropriate form from www.mycmh.org.  If you need to speak with someone regarding your medical records, you may contact the HIM department directly at 805-948-5047 Monday through Friday from 8:00 am to 4:00 pm.

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We will be closing our private practice on June 1, 2025.  Dr. Gustafson and Wendy Margolis will be transitioning to the Community Memorial Healthcare (CMHC) outpatient facility at 120 North Ashwood Avenue in Ventura.

Please click the button below to get more information

Practice Closure Information