Become A Patient

Getting Ready for Your First Visit

Complete and bring the following forms with you at your first visit. Click on links for couples, female or male individual.

• New Patient Demographics Form
• Your Financial Responsibility Form: require signatures of both partners
• Pharmacy Benefit Pre-Verification Form
• Patient Communication Instructions: require signatures of both partners
• Receipt of HIPAA Notice: each partner must sign a separate notice, total of 2 copies
• Insurance Coverage For Laboratory or Radiologic Testing
• Pre-conception Carrier Screening
• Questionnaire for Women
• Questionnaire for Men

Other documents you should read before your first visit are:

• Information Regarding Your Insurance and Costs for Infertility Care
• Patient Rights and Responsibilities
• Notice of Privacy Practice — commonly called HIPAA

Bring the following items with you at your visit:

• Valid driver license for both partners
• If a driver license is not issued, bring a valid passport with photo, or a photo ID issued by a state government
• Health insurance card, or cards if each partner has different plan
• Prescription drug card, or cards if each partner has different plan
• Special referral or pre-authorization form from your primary care provider, if required by your health plan

If you already have undergone a basic infertility workup, or if you have had fertility procedures done elsewhere, please request copies of those medical records and bring them along to your initial consult. A Request for Access to Records form is available here for your convenience. Federal law allows up to 30 days for health care providers to gather and send your medical records. So request your records as soon as possible.

If your insurance requires any special referrals or preauthorizations for infertility, please bring it with you to your initial consultation. Also confirm if ultrasounds and hormone blood tests can be performed in the specialist’s office. If not, what is the name of the specific radiology facility or laboratory you must use?

If you have specific questions or concerns, write them down and bring along at your first visit. An informed patient is the most efficient and satisfied consumer of healthcare.

Directions to our Office click here.

Your First Visit

At your first visit, a careful review of the woman’s medical history including past and current health condition will be undertaken. This can include:

• A review of the pattern of menstrual cycle and bleeding to help determine if ovulation is occurring and if other problems such as diminished reserve (aging) of the ovary or uterine defects (fibroids or polyps) are present.
• A review of past pregnancies and outcome.
• Collection of information which might suggest an anatomic problem with the tubes, such as questions about past history of sexually transmitted infections, painful periods or intercourse, and/or a previous abdominal surgery.
• Questions about prior surgery to the cervix or freezing for abnormal pap smears.
• A general review of systems to ascertain symptoms suggestive of other endocrine abnormalities which might be contributing to infertility.
• A careful social history to evaluate for any environmental exposures or social habits (such as smoking, drinking alcohol, drug usage or extreme exercise) which could contribute to the infertility.
• A detailed family history to identify possible familial diseases such as uterine fibroid, diabetes, thyroid disease, ovarian cancer and breast cancer.

If you have medical records related to previous infertility evaluation or treatment, it will be reviewed to define the cause of your infertility, evaluate the effectiveness of past treatment and assess how they impact your options.

A physical examination and/or a pelvic ultrasound may be performed at your first visit or it may be postponed to the beginning of your next menstrual cycle to evaluate the pelvic organs and assess potential hormonal problems.

Please remember to complete and bring all the required signed forms (9 for couples, 6 for individuals) with you to your first visit!