Please choose the appropriate form(s) below to assist us in getting to know you. They will open a PDF file. Please print and complete it. Please bring in any information that may help us to know your condition, such as medical test results, previous infertility treatments summary, etc….
PDF PATIENT’S HEALTH HISTORY FORMS
1. Health History Forms (6 pages): ALL patients must complete these forms prior to their first visit. OR you can fill out the electronic form below. Download the Health History Forms
2. Fertility History and Information (3 pages): these forms need to be completed in addition to the Health History Forms. Download Fertility History and Information Forms.
ELECTRONIC PATIENT’S HEALTH HISTORY FORMS
If you would prefer to submit the form electronically without printing, please follow the links below.
3. Health History Forms (7 sections): ALL patients must complete these forms prior to their first visit. OR you can fill out the PDF form above.
4. Fertility Patient Forms (6 sections): In addition to Health History Form, each patient along with their partner seeking fertility care needs to complete, sign and date these forms. OR you can fill out the PDF form above.
OTHER FORMS (PDF)
5. Auto Accident/ Work Comp Claim Information Form
6. Credit Card Authorization Form
7. Health Information Release Form