Gynecology and Obstetrics
The Women’s Center, a practice of Copley Hospital
Appointments: 8:00am-4:30pm Monday – Friday
Copley Health Center Building, 2nd Floor
530 Washington Highway
Morrisville, VT 05661
802-888-8100
Our Team of Specialists in Women’s Health
Kipp Bovey, Certified Nurse Midwife
Rebecca M. Gloss, Certified Nurse Midwife
Erinn Mandeville, Certified Nurse Midwife
Jennifer Walters, Certified Nurse Midwife
History Questionnaire
Please print and fill out the questionnaire below that applies to your visit. You may scan or take a picture of the completed document and email it to us at TheWomensCenter@chsi.org; fax it to us at (802)888-9438; or mail to The Women’s Center, 530 Washington Highway, Morrisville, VT, 05661. It is helpful, and much appreciated, to receive the completed form at least one week prior to your visit. Having this important information ahead of your visit allows you to spend more time with your provider.
Prenatal Visit: Prenatal Patient History Questionnaire
Gynecological or Other Women’s Heath Visit: Patient History Questionnaire
“How You’re Doing”
We recognize that ‘how you’re doing’ is related to more than just your health. This form asks you a number of questions on topics related to your feelings, behaviors, and other challenges you may be facing that play a role in your well-being. Please tell your medical assistant or ask our staff if you think of anything else important you’d like to share. We have the people and resources to help. Complete the form that applies to your visit ahead of time and fax, scan or mail (information above under History Questionnaire).
