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Patient Forms
Welcome to our practice! We look forward to caring for you in the future. Prior to your initial visit to Fertility & Women's Health Center of Louisiana we may ask you to complete our Patient Online Portal. This will help us be more efficient with your time and enable us to concentrate on establishing a diagnosis and treatment plan for you and your partner. For efficiency, we ask that you bring to your appointment any gyn/ob and/or hormone medical records from your past that you feel may be pertinent. Thank you very much and we look forward to meeting you!
► If you are unable to complete forms online prior to your appointment, please plan to arrive 1 hour before your scheduled appointment time.
Infertility & Gyncecology Patient Forms:
- Patient Online Portal - Click this link to fill out your Infertility & Gynecology forms online. Clicking here will take you to our e-IVF website where you will enter your unique user ID and password. All patients fill out these forms, regardless of whether you are seeing us for infertility or gynecology.
- If you are interested in becoming a patient at Fertility & Women's Health Center, please go to our Patient Online Portal and click on the link for New Patients. Your information and request will be reviewed by our medical staff and a response along with your unique User ID and Password will be e-mailed to you, generally within 24 hours.
- Fax Cover Sheet
- Photo Release Form
- Financial Policy
- Emergency Contact Form
IVF Patient Forms:
Patient Confidentiality Forms:
At Fertility & Women's Health Center of Louisiana your medical information privacy is our number one concern. Rest assured that all of your medical records are considered confidential information. Our state-of-the-art electronic medical records and patient information system complies with all HIPAA (Health Insurance Portability and Accountability Act of 1996) requirements.
Upon becoming a patient at Fertility & Women's Health Center of Louisiana, you will be required to read and sign the following forms that comply with federal HIPAA laws. On occasion, we may also ask you to update your consent and authorization.