New Patient Forms
(must be completed prior to a new patient visit at Main Line Fertility)
- Please complete, print, and sign the demographic form, save as your first and last name and e-mail to email@example.com
2. Patient Health History and Consent Forms
- You and your partner (if applicable) should print, complete and sign the form(s), save as your first and last name and e-mail completed copy to firstname.lastname@example.org
Informational Forms for Your Review
Effective Jan 1, 2019, the new IVF consents must be completed, notarized* and returned to the IVF staff prior to an IVF cycle start. *If it is not possible to have the consents notarized they must be signed by both parties in the presence of a Main Line Fertility employee after presenting photo ID prior to an IVF cycle start.
Record Request Forms
Record Requests take 7-10 business days to process from the time of receipt.
For an e-sign version of the record request, please contact email@example.com