PATIENT MEDICAL FORMS
If you are accessing this page, you have notified our receptionist that you would prefer to print and download your own forms. We cannot stress enough how important it is that you read, sign and fill out all of these forms and mail them back to our office before your first appointment (Flint, Rochester Hills, Dearborn & Ohio to Rochester Hills). Should you not have access to a printer or reliable computer, please contact our office again immediately so we may mail you a WELCOME PACKET
All your information should be in our office prior to your first office visit.
For your convenience - below is the necessary WELCOME PACKET, which need to filled out.
All documents are property of our clinic and subject to copyright law.
As a reminder, here is a list of records we need from you before your first visit (if applicable):
- Records of previous infertility treatments
- Records of infertility work-up such as: semen analysis, hysterosalpingogram report and films, or CD. You will need to pick up the films (or CD) from the hospital where the test was done, and bring them to your first appointment.
- Recent pap smear report
- Previous gynecological surgeries with pathology report (e.g. laparoscopy, hysteroscopy)
- Any laboratory test results pertaining to hormone levels or any infertility-related reports
- Any pelvic ultrasound reports
PLEASE FORWARD THE MEDICAL RELEASE FORMS, THE ABOVE LIST OF ITEMS, & ALL OTHER MEDICAL FORMS LOCATED BELOW
TO THE PERTAINING OFFICE ADDRESS (FLINT, ROCHESTER HILLS, Dearborn & Ohio to Rochester Hills) BEFORE YOUR FIRST APPOINTMENT.
All of our addresses and contact information are located here.
Again, please make sure that you have everything in our office prior to your visit, so that we may be well prepared for your consult.
Please ensure that you also bring valid form of photo ID (e.g. a drivers license, passport) as well as your current insurance card.
Please note that you must utilize Google Browser to properly download the WELCOME PACKET and Release of Records.
All your information should be in our office prior to your first office visit.
For your convenience - below is the necessary WELCOME PACKET, which need to filled out.
All documents are property of our clinic and subject to copyright law.
As a reminder, here is a list of records we need from you before your first visit (if applicable):
- Records of previous infertility treatments
- Records of infertility work-up such as: semen analysis, hysterosalpingogram report and films, or CD. You will need to pick up the films (or CD) from the hospital where the test was done, and bring them to your first appointment.
- Recent pap smear report
- Previous gynecological surgeries with pathology report (e.g. laparoscopy, hysteroscopy)
- Any laboratory test results pertaining to hormone levels or any infertility-related reports
- Any pelvic ultrasound reports
PLEASE FORWARD THE MEDICAL RELEASE FORMS, THE ABOVE LIST OF ITEMS, & ALL OTHER MEDICAL FORMS LOCATED BELOW
TO THE PERTAINING OFFICE ADDRESS (FLINT, ROCHESTER HILLS, Dearborn & Ohio to Rochester Hills) BEFORE YOUR FIRST APPOINTMENT.
All of our addresses and contact information are located here.
Again, please make sure that you have everything in our office prior to your visit, so that we may be well prepared for your consult.
Please ensure that you also bring valid form of photo ID (e.g. a drivers license, passport) as well as your current insurance card.
Please note that you must utilize Google Browser to properly download the WELCOME PACKET and Release of Records.
| info_ivfmi_rh_f_packet_2021.pdf |
| return_to_office_patient_forms-signatures_2021_welcome_packet_v_8.10.21.pdf |
| release_of_records_to_ivf.pdf |
| release_from_ivf_forms.pdf |