New Patient Information
Choosing the right fertility experts to work with and starting the process to build your family can be confusing and frustrating. Our New Patient Liaison is here to answer your questions regarding becoming a patient at SRM. An experienced clinic representative, the liaison can assist in all initial inquires to our practice and facilitate scheduling your initial consultation with one of our physicians. The New Patient Liaison can also direct you to more detailed information regarding infertility.
New Patient Registration Forms
Your new patient registration process can go much smoother when you perform the following steps.
Please print and complete the following information prior to your first visit. We do ask that you check in 20 minutes prior to your appointment in order for us to complete the registration process.
STEP 1
Please complete one of the forms below. You do not need to complete both forms. In general, if you are having trouble getting pregnant, the first form is appropriate. If there is a gynecologic issue, the second form is appropriate.
- Medical and Reproductive History - Attempting Pregnancy/ Fertility Concerns
- Medical and Reproductive History - Non-Fertility, Medical Concerns
STEP 2
Please complete these forms. There is a copy for each partner.
- Insurance Waiver and Financial Policy
- Authorization Form to Release Protected Health Information to Spouse / Significant Other
- Email Communication Consent
- Genetic Carrier Testing and Immunizations Prior to Pregnancy (Fertility patients only-one form for each couple
- Genetic Acknowledgement
STEP 3
If you need to send a medical release to another clinic / facility.
STEP 4
For your review.
- New Patient Introductory Letter - Seattle , Bellevue, Tacoma
- Directions to SRM: Seattle, Bellevue, Tacoma
- New Patient Appointment Checklist (recommended)
- Joint Notice of Privacy Practices
- Preconception Health
