Patient & Provider Forms

Forms for Patients

Some forms are multiple pages; please complete all pages.

New Patient Welcome Packet - Cancer Survivorship

New Patient Welcome Packet - Genetic Counseling

New Patient Welcome Packet - GYN Oncology

New Patient Welcome Packet - High-Risk Breast Program

Release of Medical Records Form

Forms for Providers

Referral Form

High-Risk Breast Program

Certain conditions increase a woman’s lifetime risk of developing breast cancer.

These conditions include:

  • Atypical findings on a mammogram
  • Multiple prior breast biopsies
  • Atypical findings on a previous breast biopsy
  • Family history of breast or ovarian cancer
  • Known cancer mutation in your family

Led by Charu Taneja, MD, our team of breast health specialists provide a comprehensive evaluation for individuals at risk. 

Our team will consider if any of the following are appropriate for you and will work with you to develop a plan of care:

  • Additional imaging
  • Frequent follow up
  • Genetic testing
  • Risk reduction with medication if lifetime risk is greater than 20 percent

The Women’s Medicine Collaborative is a convenient, comfortable setting dedicated to women’s health.

For more information or to schedule an appointment, call 401-793-7917.

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High-Risk Breast Program
West River Center
146 West River Street
Providence, RI 02904
3rd Floor Suite 11-D
146 West River Street
Providence, RI 02904