Patient Forms

Waiting RoomWe welcome you to the office of Dr. Michele Couri – The Couri Center for Gynecology and Integrative Women’s Health. Thank you for choosing us.  We look forward to providing you with the highest quality of care and trust.

Check in with Phreesia:

Effective December 5, 2018, you can now check in on your own device before your visit or when you arrive! you can check in with Phreesia!

 

What should I bring to my visit?

To allow us to better serve you, please complete the below Patient Information Form, Gynecologic Questionnaire and Medical Release.   If we do not receive these forms two weeks prior to your appointment, unfortunately, we will need to reschedule.

Also, please enclose a copy of the front and back of your insurance card. We take pride in providing compassionate and comprehensive gynecologic, integrative and aesthetic care, and your paperwork helps us do just that right from the start.

What is your cancellation policy?

Unless canceled at least 24 hours in advance, our policy is to charge for missed appointments at the rate of $40. Please help us serve you better by keeping scheduled appointments.

Thank you so much, we look forward to meeting you!

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