Patient Forms

Waiting Room

We welcome you to the Couri Center for Gynecology and Integrative Women’s Health. Thank you for choosing us!  To allow us to better serve you during Covid-19, we need the following information at least 24-hours prior to your appointment.

Patient Forms

NEW PATIENTS

INTEGRATIVE FOOD SENSITIVITY FORM:

EXISTING PATIENTS

Please complete and email forms to: info@couricenter.com 

It is critical we receive these forms at least 24 hours prior to your appointment time. 

INSTRUCTIONS

Print forms and fill in by hand.

  1. Scan completed documents and email to info@couricenter.com.

OR

Complete forms by filling in online as .pdf.

  1. Please open each form and save it on your computer, preferably add your last name to the file name while saving.
  2. Open the saved documents and complete each fill-in form.
  3. Save completed documents.
  4. Email completed documents as attachments to: info@couricenter.com

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.

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