Paula Bernstein PhD, MD

Menopause and Hormone Replacement

Patient Forms

We would like to have the following information at the time of your consultation so that we know as much as possible about your medical risk factors and history:

  1. Your most recent mammogram.
  2. Your bone density scan.
  3. Your most recent blood tests. In particular, we want to see a complete lipid panel, TSH and CRP.
  4. If you have had any gynecologic surgery, please send a copy of the operative report.
  5. If you have had any cardiac imaging, such as a stress test, a cardiac calcium scan, or an angiogram, please send copies of the reports.
  6. Please fill out and print our Patient History.

If you have not had a mammogram within the past year, or any blood tests within the past year, please have your primary care physician arrange to have these done before your consult.

You may bring your information with you to your appointment, or you may Fax it to:

Attn: Dr Bernstein
Patient History