Patient Forms

Patient Forms


All patients and partners must complete an intake form and all consent forms prior to your New Patient or Restart Patient Consultation.

We recommend you request any pertinent medical records from your care providers and have them sent to the office of your scheduled appointment. You can find our contact information in your Welcome Email.

Download our Patient Education Handbook

Download Helpful Patient Education Materials

Each patient who visits RMA Philadelphia is directed to complete and submit a medical intake form.

In order for our physicians to accurately assess your fertility and put together an appropriate fertility treatment plan, they will need your medical histories before your first appointment.

If you are a couple seeking fertility services, each partner will need to complete their own medical intake form and communication consents.

Please complete the appropriate forms at least 1 week before your first visit.

 

PATIENT MUST COMPLETE THE FOLLOWING FORMS:

PARTNER MUST COMPLETE THE FOLLOWING FORMS:

Please complete one of the medical records request forms below.

 

MEDICAL RECORD RELEASE FORM

Please complete this form to request your records from RMA Philadelphia. There is a fee associated with medical records.

Click here to complete the form.

 

PREGNANCY DISCHARGE RELEASE FORM

Please complete this form to request your records from RMA Philadelphia.

Click here to complete the form.

 

OUTSIDE RECORD RELEASE FORM

Please complete this form to send to another site for RMA Philadelphia to receive your medical records.

Click here to complete the form.

 

LABORATORY RELEASE FORM

The form takes approximately 10-15 minutes to complete.

Click here to complete the form.

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