Forms and Questionnaires for New Patients

Appointments and Referrals

Call us at 401-793-4636 (4MEN)
for more information about our services, or to make an appointment, or refer a patient.

Monday to Friday
8 a.m. to 4:30 p.m.


The Men's Health Center
The Miriam Hospital/Fain Building
164 Summit Avenue
Providence, RI 02906

Note: The Fain Building is a block away from the Main Building at The Miriam Hospital.

Directions and busing information >>

Print, fill out and bring these forms in for your first appointment at the Men's Health Center. All forms below are in PDF format.

For All Patients

For New Patients Who Have Not Had Prostate Surgery

For New Patients Who Have Had Prostate Surgery