Women’s Wellness Patient Forms

Please find below the necessary forms that you can download and have completed before your first appointment allowing you to be less stressed and able to focus on the history and educational portion of the initial evaluation.

Patient Registration Form Packet

Contains the Women’s Wellness Works Patient Registration, HIPPA Privacy form, Communication Authorization form, Conditions & Consent form, the Financial & Insurance Responsibilities form, and Medical History form.

If you have any questions about our forms, please email us at marci@3wpt.com. We will be more than happy to help you.

I met Marci at a time when I was feeling totally hopeless about my pelvic floor pain. Since pelvic floor therapy was something I was not familiar with, I was very apprehensive about it. When I met Marci, I was impressed with her complete professionalism and the fact that she really cares about you a… Read more

Sharon R.

I have referred numerous patients to Marci for both gynecological and obstetrical treatments. Patients report a positive experience, as well as, improvement or resolution of their symptoms. I personally received physical therapy treatment for a sports injury from Marci. She provided in office treatm… Read more

Theresa PoepperlingCNM

Last year I woke up one morning and thought that I must be developing a bladder infection. I constantly felt like I had to pee and over the next few days the sensation built and nothing would make it stop. Two urine tests were negative for infection and my symptoms grew worse. In a short period of t… Read more

Anonymous

There have been many cases of dyspareunia, vaginismus and stress urinary incontinence that I have referred to Marci with amazing results over the years. One in particular, is a woman who was unable to have intercourse with her husband for many years prior to working with Marci. She eventually became… Read more

Joanne SweeneyM.D.

Marci has been great at helping my patients with a variety of issues including pregnancy related sciatic nerve pain, incontinence and pelvic floor disorders… just to name a few. She uses the latest modalities and has a great bedside manner to make the patients feel at ease with such sensitive issu… Read more

Debra AcerenzaDO, FACOGFrederick, MD

After the birth of my second child, I began to experience intermittent pelvic pain. At 32, I also had uterine prolapse, a rectocele and cystocele. I started trying to seek out information-like what was causing the pain, how to make it stop, etc. As time went on and I felt like physicians weren’t t… Read more

Elizabeth S.

I have had the good fortune to have shared many patients with pelvic floor disorders over the last 5 yrs. She has always provided a sensitive compassionate service. My patients have profited from her knowledge and skills. We are very fortunate to have such a great resource available to the women of … Read more

Gerrit SchipperM.D.

My physical therapy through Women’s Wellness Works has been very effective and helpful, both with back pain during pregnancy and a back injury 18 months later. Marci is a kind, gentle and patient physical therapist who is discreet and professional. I recommend her services to any woman who wants a… Read more

Carrie L.

Marci helped me through pregnancy and post-pregnancy with her specialized physical therapy. Without her customized blend of massage and treatment I would have had a very painful pregnancy. With her help I was able to complete a triathlon just 6 months after delivering my baby. I would recommend her … Read more

Stacy S.

Marci is helping me with a shortened vaginal area after effects from radiation treatment for endometrial cancer. I am making excellent progress. The vaginal area is opening deeper and in circumference. Comments on websites from women who find they have radical changes in their vaginal area after rad… Read more

S. K,