New Patient Questionnaire

When you make your appointment for a New Patient Consultation, we will send you a packet of information and forms to review and complete before the appointment. This information will provide your physician with details that are important and relevant to your reproductive care. (Key forms are also available below.)

In order to prepare your chart for your initial appointment, please obtain or complete the information requested, and forward it to our office right away. If you are not able to forward the paperwork in time for it to reach us before your appointment, please bring the information with you, arriving at least 30 minutes before your appointment so we can prepare your chart.

New Patient Forms

If your appointment is only days away, you might prefer to download the PDF forms listed below, complete them, and fax them to 650-725-1345.

1. Female Patient Questionnaire
2. Male Questionnaire
3. POI Questionnaire (POI patients only)
4. Copy of health insurance card(s) – both sides (front and back)
5. Request for Release of Medical Information (OB/GYN and other relevant records)