Patient Registration Forms

In order to maximize your time during your first visit, we recommend that you print and complete the forms below prior to arrival. Please arrive 20 minutes before your scheduled appointment to allow time to complete the registration process.

Step 1

Please complete the appropriate form:

1.  Planning to have a child:

• Female patient with male partner
• Female patient, egg freezing
• Female patient with female partner (print a copy for each, if applicable)
• Female patient, single
• Male patient with male partner
• Male patient, single

2. Medical health history for those not planning pregnancy

3. Male health history for patients of Dr. Walsh or Dr. Ostrowski

4. Fertility Assessment

Step 2

Please read and sign the last three pages of the Policies and Acknowledgements Packet. Print one packet for each partner (if applicable):

• SRM Policies and Acknowledgement

Step 3

Please print and sign the Release Form if you have relevant outside medical records. These would include any prior fertility testing or treatment, or any other labs done within the past year:

• Authorization Form to Release Medical Information to SRM

Step 4

Please review the following information:

• New Patient Appointment Checklist (recommended)
• Welcome to Seattle Reproductive Medicine
• Preconception Health
• Patient Rights and Responsibilities