This area provides patient forms which you can download, complete on your computer and submit to firstname.lastname@example.org. If you submit via email and don’t hear back within 7 business days please call the office. We employ a high-security spam filter for our medical office and some mail does occasionally go astray. You may also print out the forms, complete and then return by fax or regular mail.
Fillable forms instructions
- Please right click on the form and select “save file as…” (the forms are not displayed correctly in most web browsers)
- Open the form using Adobe Reader. Using third-party applications, including Apple’s Preview, can result in problems with your submitted forms. Using an outdated version of Reader can also result in problems with your form, so make sure you have the most current version.
- Fill out the form as completely as you can. There are some fields that cannot be filled out electronically. These are meant to be signed in our office.
- After the form is filled out, save it in the following format: lastname_firstname xxxxform (xxxx= name of the specific form you are filling out)
- Email the form to email@example.com
If you are having any difficulties with the forms please email Aaron at aaron @ fertileweb.com with the nature of your problem.
For New Patients
Please fill out, and return the appropriate information packet to the clinic at least 7 days before your first appointment. If we do not receive the paperwork before your first appointment there is a chance that your appointment will have to be rescheduled to a later date. We require you to fill out the patient paperwork that applies to you (fertility vs OBGYN) and the front office paperwork. There are two versions of each form, a regular PDF and a PDF form that can be saved to your computer, filled out and submitted via email to firstname.lastname@example.org.
If you are trying to conceive at the present time, please complete both of the forms below:
If you are not trying to conceive at the present time, please complete one of the gynecology forms and the Front Office Paperwork below (Downloads should start automatically):
- Download the New Gynecology Patient Packet (PDF)
- Download the New Gynecology Patient Form (PDF form)
Front Office Paperwork: including billing policies, insurance information, demographics, and consent forms.
Insurance Questionnaire to help you check your own insurance benefits.
Additional Questionnaires and Forms
Below are some additional questionnaires and forms that may be pertinent. Download and fill out as instructed. Again, please return the filled questionnaire to us before your appointment so the medical staff may review it before you arrive for your appointment.
If you suffer from significant pelvic pain, please also complete:
- Pelvic Pain History Questionnaire – PDF file
To request records to be sent to or from the office please complete and submit the appropriate form below (please allow 10-14 days for your request to be processed):
Some helpful hints to help you deal with the wait between your transfer/insemination and the pregnancy results
- Tips To Help You Stay Sane (PDF file)
- When Infertility Makes You Anxious, Tense and Ticked Off (PDF file)