Patient Intake Forms

Welcome to Women to Women. Below, you will find our new patient paperwork. It may seem like a lot of questions, but the more we know about you, your health and your lifestyle, the better we can fulfill your need for the professional care and understanding that led you to us in the first place. Please print the paperwork listed in blue below and take a few minutes to thoroughly and thoughtfully complete the questionnaire. Also, please fill out the medication and supplement log ~ please be sure to note all of your medications and supplements. To complete your package, please read and sign our billing policy form. Your information can be mailed to:

Women to Women
3 Marina Rd
Yarmouth, ME 04096

Or faxed to: 207-846-6167

Thank you for trusting us with your care. We look forward to assisting you on your road to optimum wellness.

• New Patient Paper Work
• PC Waiver Insurance Opt-Out Form
• Medical Symptoms Questionnaire
• Record Release Form

Annual Forms:

• Annual Form
• Annual Follow-Up Form & 3 Day Diet Log

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We invite you to become our patient

Over the past 25 years our practitioners have helped thousands of women restore their health and well-being.

We often detect underlying imbalances that conventional practitioners miss. Over the years we have developed a specialization resolving the symptoms of:

• Adrenal Imbalance
• Thyroid Imbalance
• Depression or Anxiety
• Menopause and Perimenopause
• PMS
• Digestive Problems

We invite you to book an appointment now by calling 1-800-540-5906. If you cannot make the trip to Maine, we offer phone consultations both for new patients and for follow-up care with patients that live far away.

To book an appointment at either the clinic or via the phone, please call us toll free at 1-800-540-5906 now.