From the Day a Diagnosis of Cancer is Made, Survivorship Begins

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

Cancer Survivorship Referral Form

“I Am,” the Women’s Medicine Collaborative cancer survivorship program, is an interdisciplinary, holistic model of care that addresses all facets of a woman’s quality of life.

Our patients tell us: “I am a mother.” “I am a wife.” “I am a neighbor.” “I am a friend.”

We recognize our patients as women living with cancer, and offer individualized care plans to optimize well-being and assist in recovery.

Our Cancer Survivorship program is open to women who have any type of cancer. Women come to see us as soon as the week after their treatment ends and some come many years after treatment has ended. You are welcome at anytime.

Working in collaboration with the Lifespan Cancer Institute, our multidisciplinary team of caring, experienced providers understands that women with cancer are more than their diagnoses.

"I feel that every member of this team always and consistently goes the extra mile to make the patient experience so positive. The team is so caring and that makes a huge difference in my healing. I think access to the Lifestyle Medicine Center programs is another example of above and beyond and I am grateful to Dr. Wiggins and her team for the Survivorship care after treatment." - Tracey, 49 years old, Wakefield, RI

Doreen Wiggins, MD and Amy Pilotte, NP provide a comprehensive evaluation and plan of care, including:

  • Cancer treatment summary
  • Recommendations for cancer surveillance and risk reduction strategies
  • Vaccine therapy
  • Nutrition counseling
  • Exercise recommendations
  • Lymphedema therapy
  • Counseling for anxiety and depression
  • Stress management strategies
  • Genetic susceptibility assessment
  • Answers to sexuality and reproductive concerns

Our holistic, integrative approach also provides critical services to address a myriad of emotional, psychological and financial challenges.  We help many of our patients who have fear of recurrence, depression, problems adjusting to physical changes, employment and insurance issues, and who are facing a sense of loss for what might have been (e.g., loss of fertility).

Women are asked to speak with their primary care provider or oncologist to get a referral to our program. Once your referral is received, a member of our care team will contact you to make an appointment with one of our cancer survivorship specialists, Dr. Doreen Wiggins or Amy Pilotte, NP. 

Following your one-on-one visit, you may be invited to attend a shared medical appointment. In this enhanced medical appointment, cancer survivors meet with the provider as well as a medical assistant and group facilitator. Along with receiving individualized attention, it is an opportunity to help and support one another by sharing experiences.

Learn more about shared medical appointments.

Our providers work in partnership with Women’s Medicine Collaborative’s Center for Gynecologic Cancers, High-Risk Breast ProgramLifestyle Medicine Centerphysical therapy services and women's genetic counseling services.

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Locations

Women's Cancer Survivorship Program: "I Am"
West River Center
146 West River Street
Providence, RI 02904
3rd Floor Suite 11-D
146 West River Street
Providence, RI 02904