Forms and policies

For your convenience, you can go ahead and download and print the forms below before your visit. Feel free to bring them with you to your appointment or fax them to us ahead of time, whichever works best for you.

Patient Information

Consent to Treatment [pdf]

Release of HIPAA [pdf]

Acknowledgement of Cancellation Policy  [pdf]

Patient History Questionnaire [pdf]

Resources for your well-being

Terra Fertility – Dr. Pietro E. Bortoletto, MD, MSc.

South Shore Health- Dr. Danielle Carr, MD / Specialty Urogynecology

Newton-Wellesley Hospital- Dr. Hilary Haber, MD. Minimally Invasive Gynecologic Surgery

The Women’s Center of South Shore Medical Center