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Patient Paperwork and Resources
For your convenience, all of our patient paperwork and educational resources can be found on our Artemis Patient Portal App or below. If you have any questions or issues completing your paperwork please reach out to your care team. Click the links below to jump to the section you'd like to navigate to.
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.
HIPAA PRIVACY POLICY
Click here to download the form.
PATIENT CONSENT FOR USE OF ELECTRONIC MAIL
Coming soon
Each patient who visits RMANJ must 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. If you are seeking our services as a couple, each partner in the couple must complete his or her intake form.
Please complete the appropriate forms and return them to our office 1-2 weeks before your new patient appointment.
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.
RETURNING FEMALE INTAKE FORM
This is the Returning Female Intake Form, depending on your health history. It should take you between five to ten minutes to complete.
Click here to complete 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.
DEMOGRAPHIC FORM
This form collects your basic demographic information. It should take five to ten minutes to complete.
SUMMARY HISTORY FORM
This form collects your infertility history. It should take five to ten minutes to complete.
FPC INTAKE FORM
This details the medical history for patients that have undergone chemotherapy or are going to undergo chemotherapy. It should take five to ten minutes to complete.
TRANSGENDER INTAKE FORM
This is the Transgender Intake Form. It should take five to ten minutes to complete.
MEDICAL RECORD AUTHORIZATION FORM
This is the Medical Records Authorization Form. It should take five to ten minutes to complete.
These additional forms will be provided to you upon arrival at your new patient appointment. To assist in the efficiency during registration, you may elect to complete these forms below in advance.
Please complete all forms and return them to our office 1-2 weeks before your new patient appointment.
PATIENT CONSENT FOR USE OF ELECTRONIC MAIL
PATIENT PRIVACY FORM
OUTSIDE REFERRAL FORM
AUTHORIZATION FOR RELEASE OF PREGNANCY DISCHARGE RECORDS
CREDIT CARD AUTHORIZATION FORM
COMMUNICATION FORM
FINANCIAL POLICY FORM
Please complete the provided medical record release and send it to your OB/GYN, urologist, previous fertility center, or another medical provider to request your medical records.
We request a copy of your previous medical records to be forwarded to our office 1-2 weeks before your new patient appointment.
MEDICAL RECORD RELEASE FORM
Click here to download the form.
UROLOGY MEDICAL RELEASE FORM
Click here to download the form.
Reproductive Medicine Associates of New Jersey (RMANJ) 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 973-290-8370 or dropped off in person at any RMANJ location.
MEDICAL RELEASE AUTHORIZATION FORM
MENTAL HEALTH CARE AUTHORIZATION
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 RMANJ. To ensure every patient is satisfied, here at RMANJ, we have developed guidelines for canceling and rescheduling new patient appointments. Please review the following and call the patient liaison department at 973-656-2089 with any questions: If it becomes necessary for you to cancel your appointment, we require at least 72 hour notice, so that we can contact other patients who may be able to take your scheduled appointment. If you do not contact us, RMANJ can bill you for the missed visit.
CANCELLATION RESCHEDULE POLICY
If you have canceled or rescheduled your appointment under 72 hours, RMANJ 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 a $250.00 fee for the initial consultation fee and when you come in for your consultation, you will be reimbursed this fee minus your co-pay.
CREDIT CARD AUTHORIZATION FORM
CHILDREN IN WAITING ROOM POLICY
We politely ask that all patients refrain from bringing children into our waiting rooms. We are sensitive to the many emotions of infertility and appreciate our patients showing understanding by making separate childcare accommodations.
Additionally, healthcare facility visitation restrictions and guidelines related to the COVID-19 pandemic make it critical that only patients enter our offices at this time.
Thank you for your understanding and compliance with this policy.
HIPAA PRIVACY POLICY
PACU VISITATION POLICY
POLICY REGARDING AGE AND INFERTILITY TREATMENT
Each patient who visits RMA 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. If you are seeking our services as an individual or 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.
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.
RETURNING FEMALE INTAKE FORM
This is the Returning Female Intake Form, depending on your health history. It should take you between five to ten minutes to complete.
Click here to complete 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 complete the form
FERTILITY PRESERVATION INTAKE FORM
This is the FPC Intake Form. It should take five to ten minutes to complete.
Click here to complete the form
TRANSGENDER INTAKE FORM
This is the Transgender Intake Form. It should take five to ten minutes to complete.
Click here to complete the form
DEMOGRAPHIC FORM
This form collects your basic demographic information. It should take five to ten minutes to complete.
Click here to complete the form
SUMMARY HISTORY FORM
This form collects your infertility history. It should take five to ten minutes to complete.
Click here to complete the form
MEDICAL RECORD AUTHORIZATION FORM
This is the Medical Records Authorization Form. It should take five to ten minutes to complete.
Click here to complete the form
HIPAA PRIVACY POLICY
Click here to complete the form
OUTSIDE REFERRAL FORM
Click here to complete the form
COMMUNICATION FORM
Click here to complete the form (Patient)
Click here to complete the form (Partner)
FINANCIAL POLICY FORM
Click here to complete the form
OUTSIDE MONITORING PATIENT FORM
Click here to complete the form
CREDIT CARD AUTHORIZATION FORM
Click here to complete the form.
PATIENT CONSENT FOR USE OF ELECTRONIC MAIL
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.
OUTSIDE REFERRAL FORM
Click here to complete the form.
PATIENT CONSENT FOR USE OF ELECTRONIC MAIL
Click here to download the form.
COMMUNICATION FORM
Click here to complete the form.
FINANCIAL POLICY FORM
Please complete the provided medical record release and send it to your OB/GYN, urologist, previous fertility center, or another medical provider to request your medical records.
We request a copy of your previous medical records to be forwarded to our office 1-2 weeks before your new patient appointment.
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 canceled 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.
HIPAA PRIVACY POLICY
All patients and partners must complete an intake form and all consent forms prior to your New Patient or Restart Patient Consultation. You can complete these forms by using RMA's Artemis Patient Portal App.
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
PATIENT CONSENT FOR USE OF ELECTRONIC MAIL
Click here to download the form.
MEDICAL RECORD RELEASE FORM
Please complete this form to request your records from RMA Philadelphia. Note: There is a fee for this request.
Click here to complete the form.
PREGNANCY DISCHARGE RELEASE FORM
Please complete this form to request your records from RMA Philadelphia to your OB/GYN.
Click here to complete the form.
HIPAA PRIVACY POLICY
Coming soon
Every patient who comes to RMA Southern California 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.
FERTILITY PRESERVATION INTAKE FORM (ONCOLOGY PATIENTS ONLY)
This is the FPC Intake Form. 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.
Please click below to download the provided medical record release and send it to your previous fertility care provider, OB/GYN, urologist, or other medical providers to request your medical records.
It’s vital for us to receive a copy of your records one to two weeks before your new patient consultation. You can fax them to our office or drop them off in-person at your convenience. You can also contact our patient liaison team if you’d like to submit them electronically to our secure email address.
MEDICAL RELEASE FORM
Click here to download the form.
Reproductive Medicine Associates of Southern California 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 424-293-8842 or dropped off in person.
MEDICAL RECORD RELEASE FORM
Click here to download the form.
MENTAL HEALTH CARE AUTHORIZATION FORM
Click here to download the form.
These additional forms will be provided to you upon arrival at your new patient appointment. To assist in the efficiency during registration, you may elect to complete these forms below in advance.
Please complete all forms and return them to our office 1-2 weeks before your new patient appointment.
PATIENT CONSENT FOR USE OF ELECTRONIC MAIL
Click here to download the form.
HIPAA PRIVACY POLICY
Click here to download the form.
OUTSIDE REFERRAL FORM
Click here to download the form.
PATIENT NON-DISCRIMINATION-POLICY
Click here to download the form.
CANCELLATION POLICY
One of the most stressful parts of receiving fertility care is often waiting for an appointment. We ask you to be considerate of other patients who are waiting for an appointment at RMA Southern California by reviewing our guidelines concerning cancellations and rescheduling. If you have any questions about these policies, please contact our patient liaison department. Please remember that we require at least 48 hours notice if you must cancel your appointment. We’ll use this time to contact our other patients who may be able to take advantage of your appointment time. Please note that if you miss a visit at RMA Southern California without contacting us, we will bill you for the visit.
CANCELLATION RESCHEDULE POLICY
After three appointment cancellations, RMA Southern California will request that you complete a Credit Card Authorization Form for payment. This helps us ensure your commitment to your next rescheduled visit. You will be charged for the initial consultation fee, and after your consultation, we will reimburse this fee minus your copay.
UPDATE YOUR INSURANCE INFORMATION
If you are an existing patient and need to update the insurance information we have on file for you click here.
Make an Online Payment
You can use this portal to make payments on existing statements or to submit payment on your account for future services. After entering your name and payment amount below, you will be redirected to our secure payment page where you will be asked to complete a simple form to submit payment. We ask that you fill out the requested information completely, including a valid e-mail address and daytime contact phone number.
NOTICE: By selecting this link, you will be leaving www.rmanetwork.com and entering a website hosted by PayJunction.com. Although RMA has approved payjunction.com as a reliable partner site, please be advised that you will no longer be subject to the privacy and security policies of www.rmanetwork.com’s website.
Please make sure that you are making your payment for the correct office. If your payment is submitted under the wrong account it will delay the processing of your payment.
Please note that RMA is no longer accepting AMEX and Discover. If you try and submit payment with AMEX or Discover, it will be declined. Please use another form of payment.
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