San Diego Fertility Center
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Forms and Instructions

Forms and Instructions

Before we can make your first appointment, you must complete our new patient forms.  The Patient Registration form, New Patient Questionnaire, and Medical Records Release form will provide us with the information we need to assist you appropriately.  All these forms should be completed and sent to their appropriate destinations prior to your first visit.

"Everyone was a pleasure to work with and made me and my husband feel very comfortable about everything. There was never a doubt that we were under the very best care."

Whether you are a local, national, or international patient, you can find the registration forms online. Complete each form, then fax (858-794-6360) or e-mail (contact our New Patient Coordinator) the Patient Registration and New Patient Questionnaire. Please send the Medical Records Release to your previous physician.

Patient Registration: Your name, contact information, insurance information,
referral information, and an authorization for insurance and payment.

New Patient Questionnaire: Answer a series of questions about your medical
and family health history and include results from previous blood and infertility tests.

Medical Records Release: Complete this form and fax or mail it to your previous
physician so that we can access your prior medical records and history.


Records Transfer Form: If you need to have your records released to a doctor outside of
San Diego Fertility Center, please complete this form. Not required for SDFC patients.
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11515 El Camino Real, Suite 100, San Diego, CA, 92130
2020 Camino Del Rio N. Suite 805, San Diego, CA, 92108
44274 George Cushman Court, Suite 201, Temecula, CA 92592
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