Resources/Forms

Forms

Health History Questionnaire (for women younger than 45 who are not experiencing perimenopausal or hormonal deficiency symptoms). Completing this form helps Anne Marie quickly review your medical history and symptoms with you.

Menopause Health History Questionnaire (for women younger 45 and other or who are experiencing menopausal or hormonal deficiency symptoms). Completing this form helps Anne Marie quickly review your medical history and symptoms with you. This more comprehensive questions has more detailed questions for evaluation of menopause and hormone concerns.

Release Form for requesting your records for Anne Marie from a previous provider.

Partners in Your Care

Quest Laboratories — Find Quest Lab locations here. With lots of locations, Quest may have a location closer to your home or office. If so, Anne Marie can place your order with the lab that’s most convenient to you.

Oregon Imaging Centers — Needing a mammogram? Other imaging? Once Anne Marie has recommended screening or diagnostic imaging, you can schedule with the Oregon Imaging Centers location for your procedure.

Maggie T. Ankeny, Psychiatric Mental Health Nurse Practitioner – Provides psychiatric and mental health counseling, medication, and referrals.

Caryn Gillen – Weight loss coach for professional women who are ready for big change. in Eugene.

Products

MiddlesexMD — Enjoy sexuality for life! Advice and products that can help.