Office Policies

Dr. Mayhew and her staff are dedicated to providing you the best service possible. It is important that you understand that For Women By Women puts you, and not your insurance company, in charge of your healthcare.

BILLING: Patients paying in cash receive a 20% discount from our normal fee schedule, except for Medicare. Discounted fee schedule do not apply to laser or cosmetic treatments. For your convenience, we accept payments by cash, check, Visa, MasterCard, and CareCredit.

ACCOUNT FEES: Past due patient balances may incur the greater of a $20.00 billing charge per month or interest at an annual rate of 18%. A fee of $25.00 will be charged for each returned check.

RECORDS & FORMS: The completion of any disability forms will incur a $50.00 administrative charge. Duplication of medical records is $30.00 – $50.00. Patients are encouraged to keep their own copies of medical records.

PATIENT INFORMATION: You will be asked to fill out a patient information form at your initial visit (or see below to download and fill out today) and each year thereafter. In order to keep your file up to date, please inform us of any changes of information such as insurance, address, and telephone number.

MISSED APPOINTMENTS: Unless canceled 24 hours in advance, you may be charged $50.00 for a missed appointment. Please help us serve our patients better by keeping scheduled appointments.

PRIVACY (HIPAA): Click here to download a pdf of the HIPAA Privacy information.

Patient Forms

Dr. Mayhew welcomes new patients and will do an initial physical examination, along with a patient interview. New patients may download the new patient form and complete it prior to the first visit to expedite the appointment. Dr. Mayhew welcomes referrals and encourages mothers of daughters to bring them in at the onset of puberty.

Some additional forms for new patients:

Patients may also review our financial form linked here.

You can download the full new patient form packet here.


Insurance policy provisions have for some time dictated which services can be provided, the timing of those services, and the reimbursement rate for services. Not only have these provisions adversely impacted the quality of care, they have also reduced the doctor-patient relationship to an occasional brief encounter. We feel our patients deserve better.

Your individual insurance plan is an agreement between you and your insurance company. It is your responsibility to know the specific details of your own plan and it is especially important for you to notify us if there are restrictions regarding referrals, labs, or services to be performed by outside facilities or specialists. You may be responsible for charges if they are not contracted with your insurance company or you have not received proper pre-authorization. You will also be responsible for any “non-covered services.”