New Patient Forms
- New Patient Checklist
- For your review
- COVID-19 Consent for Care
- You and your partner (if applicable) should print, complete and sign the form(s) and bring to your first appointment
- Demographic Form
- Please complete demographic form, save as your first and last name and email to email@example.com
- Patient Health History and Consent Forms
- You and your partner (if applicable) should choose the form(s) most appropriate for you. Please complete, print, and sign the form(s) and bring to your first appointment or email to firstname.lastname@example.org.
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.