We would like to welcome you to the office of Dr. Michele Couri – the Couri Center for Gynecology and Integrative Women’s Health and thank you for choosing us as your women’s healthcare professionals.

To allow us to better serve you, we have enclosed a Patient Information and Gynecologic Questionnaire. Please complete and return all forms, if we do not receive these forms two week prior to your appointment, unfortunately we will ask you to reschedule.  We take pride in providing the utmost in compassionate and comprehensive obstetric, gynecologic, and integrative care, and that paperwork helps us do just that right from the start.  Also, please enclose a copy of the front and back of your insurance card.

Unless cancelled 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, and we look forward to meeting you!

Gynecologic New Patient Forms

Gynecologic Questionnaire

Integrative Medicine New Patient Forms

Medical Release Form