Patient Forms

The forms listed below are available for our patients’ convenience.  You many download, print and complete the forms prior to coming in for an appointment.  We hope bringing these completed forms with you will save time and make your arrival and visit easier.

Contact Information Update & Patient Portal Activation Form – it is important for us to have up-to-date contact information to be able to reach you with test results, appointment information or other vital information.  We all know how email addresses, cell phone numbers and addresses change over time.  Completing this when you are coming in for an appointment or other times when you know you’ve had a status change is important.  This form also enables Patient Portal Activation if desired.

HIPAA (Notice of Privacy Practices) – This document is informational only, nothing to fill-out or sign.

Patient Registration Form – Please complete this registration form in its entirety and sign the bottom of the Assignment of Benefits section (authorizing us to bill your insurance) as well as the Acknowledgement of Receipt of Privacy Practices section.  Our Notice of Privacy Practices is posted in all of our offices and may be accessed by clicking the link above.

Verbal Disclosure of Information Authorization Form – This form authorizes the physicians or staff at WHCMA to discuss aspects of your protected health information with designated family members or others whom you specify.  We ask you to indicate your preferences regarding receipt of messages from our office for communications such as telephone appointment confirmations or test results.

WHCMA Authorization for the Disclosure of PHI (Medical Record Release) – This form may be used either to request records from others be released to WHCMA or for WHCMA to release records to other parties.

Obstetrical Patients

Obstetrical Care Form
Prenatal Genetic Questionnaire

 Our Locations


325 Thompson Road
Webster, MA 01570 

 Mon-Fri 8:30-5:00

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340 Maple Street, Suite 125
Marlborough, MA 01752 

 Mon-Fri 8:30-5:00

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328 Shrewsbury Street, Suite 100
Worcester, MA 01604 

 Mon-Fri 8:30-5:00

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164 South Street
Southbridge, MA 01550 

 Mon-Fri 8:30-5:00

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 Connect With Us

17 Jul: Voted 2018 baystateparent BEST OB/GYN Practice!!

Voted Baystate Parent Magazine’s BEST Ob/Gyn Practice!! Women’s Health of Central MA was voted 2018’s BEST OBSTETRICS & GYNECOLOGY PRACTICE by baystateparent magazine readers for a third year in a row!  We are honored and humbled by the title. Thank you!!!! Sincere thanks to our wonderful patients and friends who took time out of their busy lives to vote for Women’s Health.  Our physicians, midwife and compassionate staff are focused and dedicated to providing outstanding care to our patients.  It is an exciting time for the practice as it continues to grow.  In addition to our main office on Shrewsbury Street in Worcester and our two offices in…

16 Feb: Birth Control: What’s Safe, What’s Not

As a woman, you have a lot of choices today when it comes to birth control methods, giving you and your partner control over when – or if – you become parents. But with birth control (also called contraception), different people have different needs. Each method has its pros and cons – including health risks.