New Patient Forms

Each new patient must complete several forms prior to his or her first visit to the Fertility Center. 
All patients provide personal information while only women submit the gynecology questionnaire. Three forms relate to insurance; two help determine diagnostic and treatment coverage and one grants our offices permission to file insurance. We also ask that each patient sign a surgery location disclosure statement.

Please bring your completed forms to the office and arrive 15 minutes early for your first appointment, if possible, to give the receptionist time to review your paperwork and answer any questions. Our goal is to keep your waiting time to a minimum. 

Click below to browse the forms:

        Patient Information

        Gynecology Questionnaire

        Insurance Information

        Insurance Verification

        Insurance Filing

        Surgery Location Disclosure