Congratulations on taking the next step on your fertility journey – seeking the help of a reproductive endocrinology and infertility specialist at Fertility Specialists Medical Group! We are looking forward to partnering with you.
Patient registration forms
Prior to your first appointment, please print and fill out all of the patient registration HIPAA forms below.
- Authorization to Request Medical Records
- Authorization for FSMG to Release Medical Information/Records
- FSMG Financial Policy
- Patient Information
- Patient Insurance Information
- New Patient Questionnaire – Female (fill out for each female partner)
- New Patient Questionnaire – Male (fill out for each male partner)
- Notice of Privacy Practices
Patient registration and initial consultation information
Our goal is to provide a comprehensive and individualized assessment to help our patients achieve their reproductive goals.
The initial consultation typically takes between 1½ – 2 hours, depending upon the patient’s individual clinical circumstances.
- Patients should either bring or send us a copy of all medical records that may be relevant to their condition, including test results, surgical reports, etc.
- During the initial consultation, we will review each patient’s health history and perform a physical examination, including a vaginal ultrasound for female patients.
- After meeting with a physician, a staff member will review any additional testing that is needed and provide appropriate lab slips and instructions. These tests can usually be completed within four weeks or one menstrual cycle.
- Patients will also have the opportunity to meet with a member of our financial team to review any insurance benefits and treatment costs.
- We strive to provide complete and accurate information at all times. Patients are encouraged to prepare a list of questions regarding both clinical care and finances prior to their first visit.
Additional patient paperwork or medical forms
The following are subsequent patient visits or prospective circumstances that may require additional paperwork, follow-up or coordination.
After the initial consultation with one of our physicians, patients will be scheduled for a return visit to review all findings from the initial visit and any additional testing that is recommended.
This important appointment enables the patient or couple and the doctor to review treatment options and reproductive goals to ensure the patient can make an educated decision on proceeding with a treatment plan.
If an insurance plan requires a referral for the patient to utilize fertility coverage for a consultation, it is the responsibility of the patient to ensure that the authorization process is completed prior to the initial visit. After the initial visit, all follow-up authorizations will be handled by our office, if possible.
Payment & insurance coverage
Many patients, though not all, have some insurance coverage for consultations, initial testing, laboratory fees and for further testing to diagnose an infertility condition. It is the patient’s responsibility to know what is covered by her or his insurance provider, as ultimately the patient is financially responsible for all charges.
Our staff can assist patients in verifying insurance benefits and will file insurance claims for covered charges to those HMO/PPO plans with which we are contracted providers.
For the protection of our patients, we request that any information received from an insurance company be in writing. Patients should always keep a record of the date, time and name of the insurance representative with whom they spoke.