To facilitate your first visit we ask that you kindly forward to our office any relevant clinical re 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information, including your name, birthdate, and contact details. Ensure accuracy as this will be used for appointment scheduling.
  3. Complete the insurance section thoroughly. Include both primary and secondary insurance details if applicable, along with the insured person's information.
  4. Fill out the medical history sections carefully. This includes allergies, medications, menstrual history, and any previous infertility treatments. Be as detailed as possible to assist your healthcare provider.
  5. Review all entries for completeness and accuracy before submitting. Make sure to sign where indicated to authorize the release of information.

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