New Patient Forms & Medical Release

Once your appointment is scheduled, you will receive a username and password for our online eIVF Patient Portal to complete a New Patient Information Packet.

Please complete all paperwork at least two weeks prior to your first visit.

Conceptions requires all medical records be received 48 hours prior to your consult.

It is important to understand your insurance coverage and to follow the referral guidelines set forth by your insurance company. When scheduling your initial appointment, one of our patient liaisons will be available to walk you through the referral/insurance maze to help ensure you obtain the appropriate referrals or authorizations before treatment is initiated.

Patient Forms

New Patient Appointment Form New Patient Appointment Form  
updated-conceptions-brochure.pdf Conceptions Fertility Brochure 5/6/2013
INFORMED-CONSENT-Carrier-Disease-Screening-and-Single-Gene-Testing.pdf INFORMED-CONSENT-Carrier-Disease-Screening-and-Single-Gene-Testing 5/13/2015
INFORMED-CONSENT-CCS-and-Cryo-Storage.pdf INFORMED-CONSENT-CCS-and-Cryo-Storage 5/13/2015
INFORMED-CONSENT-CHROMOSOME-ANALYSIS-(Non-eIVF) INFORMED-CONSENT-CHROMOSOME-ANALYSIS-(Non-eIVF) 5/13/2015
INFORMED-CONSENT-GENETIC-CARRIER-SCREENING.pdf INFORMED-CONSENT-GENETIC-CARRIER-SCREENING 4/17/2015
Medical-Records-Release-Form.pdf Medical-Records-Release-Form 1/23/2017

Assisted Reproductive Technologies

In the event that pregnancy is not achieved after comprehensive evaluation and simpler therapies, assisted reproductive technologies (ART) are an option. When you choose to undergo these technical and demanding procedures, Conceptions provides a personal, multidisciplinary team to help facilitate your experience.

While other ART procedures (GIFT and ZIFT) are offered, in vitro fertilization is the most commonly performed ART. Our physicians are experts in this infertility treatment, and over 5,000 IVF procedures have been performed at Conceptions with exceptional results. In fact, our extensive training, breadth of experience and rigorous laboratory standards make our IVF success rates among the highest in the nation.

Conceptions strives to ensure our ART patients fully understand the IVF process from start to finish, including the risks that this treatment might pose to the patient or offspring. Prior to treatment, please review and sign the Informed Consent forms below:

INFORMED-CONSENT-Carrier-Disease-Screening-and-Single-Gene-Testing.pdf INFORMED-CONSENT-Carrier-Disease-Screening-and-Single-Gene-Testing 5/13/2015
INFORMED-CONSENT-CCS-and-Cryo-Storage.pdf INFORMED-CONSENT-CCS-and-Cryo-Storage 5/13/2015
INFORMED-CONSENT-CHROMOSOME-ANALYSIS-(Non-eIVF) INFORMED-CONSENT-CHROMOSOME-ANALYSIS-(Non-eIVF) 5/13/2015
INFORMED-CONSENT-GENETIC-CARRIER-SCREENING.pdf INFORMED-CONSENT-GENETIC-CARRIER-SCREENING 4/17/2015

HIPAA Policies

As part of a general effort to attain additional health care reform, the Health Insurance Portability and Accountability Act (HIPAA) was introduced by Congress in 1996. The law consists of several components, including the Privacy Rule.

The HIPAA "Privacy Rule" requires all healthcare providers to institute a complete strategy for maintaining the privacy of their patients and their confidential health information.

Conceptions takes the utmost care in protecting patient privacy, and adheres strictly to the stringent guidelines mandated by HIPAA policies. While the nature of healthcare necessitates the disclosure of some personal medical information to obtain appropriate treatment, Conceptions has numerous patient privacy practices in place to ensure your fundamental safety.