New Patient Forms
(must be completed prior to a new patient visit at Main Line Fertility)

1.Demographic Form

2. Patient Health History and Consent Forms

3. COVID-19 Consent for Care

    • 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 forms@mainlinefertility.com

Informational Forms for Your Review

New Patient Checklist

Carrier Screening Information

Notice of Privacy Practices

Gynecology New Patient Forms

Gynecology Patient Intake Form

Gynecology Patient Consents

Gynecology Medical History Form

  • You should  print, complete and sign the forms and bring to your first appointment

IVF Orientation Forms

IVF orientation form must be completed by all IVF patients and Biopsy for PGT should be completed by all IVF patients considering PGT as well.

IVF Consents

The below IVF consents are available via e-sign. If you are not able to utilize e-sign for these documents, all forms must then 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 support@mainlinefertility.com

Please send your completed forms to forms@mainlinefertility.com or via fax to your primary office location.