Each patient who visits Reproductive Medicine Associates of Northern California is directed to complete and submit a medical intake form. These medical histories allow our physicians to make the most accurate assessments of your fertility status and devise the most appropriate treatment plans. Please select the intake form that most accurately reflects you as a patient. For instance, if you are struggling to conceive for the first time or have experienced multiple miscarriages, please select the Female Medical Intake form. If you are interested in Egg Freezing, please select the Elective Fertility Preservation form. If you are seeking our services as a couple, each partner in the couple must complete his or her own intake form.

Please complete the appropriate forms and return them to our office 1-2 weeks before your new patient appointment. They may be faxed to 415-644-0124 or dropped off in person. If you would like to send them electronically, please contact our patient liaison team for a secure email link at 415-603-6999.

FEMALE INTAKE FORM

This is the Female Intake Form, depending on your health history. It should take you between five to ten minutes to complete.

Click here to download the form.

MALE INTAKE FORM

This is the Male Intake Form, depending on your health history. It should take you between five to ten minutes to complete.

Click here to download the form.

DEMOGRAPHIC FORM

This form collects your basic demographic information. It should take five to ten minutes to complete.

Click here to download the form.

TRANSGENDER INTAKE FORM

This is the Transgender Intake Form. It should take five to ten minutes to complete.

Click here to download the form.

ELECTIVE FERTILITY PRESERVATION INTAKE FORM

This is the Elective Fertility Preservation Intake Form. It should take five to ten minutes to complete.

Click here to download the form.

MEDICAL FERTILITY PRESERVATION INTAKE FORM

This is the Medical Fertility Preservation Intake Form. It should take five to ten minutes to complete.

Click here to download the form.

CANCELLATION POLICY

As you know, waiting for an appointment to begin fertility treatment can be stressful, so we ask you to be considerate of other patients who are waiting for their appointment with Reproductive Medicine Associates of Northern California. To ensure every patient is satisfied, here at Reproductive Medicine Associates of Northern California, we have developed guidelines for canceling and rescheduling new patient appointments. Please review the following and call the patient liaison department at 415-603-6999 with any questions: If it becomes necessary for you to cancel your appointment, we require at least 48 hour notice, so that we can contact other patients who may be able to take your scheduled appointment. If you do not contact us, Reproductive Medicine Associates of Northern California can bill you for the missed visit.

CANCELLATION RESCHEDULE POLICY

If you have cancelled your appointment three times, Reproductive Medicine Associates of Northern California will ask you to complete a Credit Card Authorization Form for payment. This will ensure us of your commitment to your next rescheduled visit. You will be charged for the initial consultation fee and when you come in for your consultation, you will be reimbursed this fee minus your co-pay.