Every patient who comes to RMA Florida for fertility care must complete and submit a medical intake form. This medical history will allow your physicians and care team to make the most accurate assessments possible concerning your fertility status, and this helps them devise the most effective treatment plans possible. Select the intake form that most appropriately describes you as a patient. Couples seeking services will need to complete patient intake forms for each partner.

Please review and complete the appropriate forms, then return them to our office one to two weeks prior to your first appointment. You may fax them to our office or drop them off in-person.

 

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.

 

SUMMARY HISTORY FORM

This form collects your infertility history. It should take five to ten minutes to complete.

Click here to download the form.

RMA Florida understands and acknowledges the need for our patients to have access to their personal medical records. Medical release authorization forms can be accessed and downloaded below. Depending on how you are submitting your request for medical records, please allow at least 1-2 weeks of processing time. Digital delivery like email or fax may take the shortest time, compared to hard copy requests that need to be mailed.

Completed medical release forms may be faxed to 407-804-9670 or dropped off in person at any RMA Florida location.

 

MEDICAL RECORD RELEASE FORM

Click here to download the form.

 

MENTAL HEALTH CARE AUTHORIZATION FORM

Click here to download the form.