Forms and Policies

We ask all new patients to please request a copy of her medical records from your previous physician prior to the first appointment with Women’s Health Group of Manchester. A Medical Records Release Form authorizes your previous physician to send this information to us. Please be sure to bring any necessary forms as well as your insurance card, a photo ID and applicable co-payment to your first appointment.

Forms:

For your convenience, Women’s Health Group of Manchester provides the following forms for download and completion before visiting the office. If you prefer to complete the necessary forms upon arrival at our office, we ask that you arrive 10 minutes prior to your scheduled appointment time to do so. At regular intervals, you will be asked to update this information.

• Registration Form
• Patient Intake Form
• Confidential Communications Request Form
• Notice of Privacy
• Medication List
• Medical Records Release Form

Please save completed forms and email them to Cindy Underhill at cunderhill@womenshealthusa.com or print and fax them to 860-643-2123. With questions on form completion, call our office at (860) 649-6199.

The forms above are in PDF format and require Adobe Acrobat or Adobe Acrobat Reader. Acrobat Reader is downloadable for free on Adobe's website. Interactive forms opened and completed in Safari will not save changes made in the PDF.

These policies are provided for your reference:

• Prescription Policy
• Results Policy
• See Locations and Office Hours for appointment policies

Thank you for choosing Women's Health Group of Manchester for your gynecologic care.