New Patient Forms

New Patient Forms

Before your initial consultation at RMA of Southern California, you will need to provide your medical records that pertain to your care and various other documents. By providing these materials ahead of time, the RMA of Southern California team can prepare for your visit and make your time with us as effective and productive as possible. You can download all of the forms you will need directly from our website. If you have medical insurance, it is important to provide all the necessary information regarding your insurance.  All patients receive a thorough benefit check before their initial consultation.  You will be notified about your coverage within our field of medicine before you meet with your physician.

Please take your time reviewing the required paperwork. Complete and deliver the following forms at least one to two weeks before your first appointment.

Please note that some visitors may need to download Adobe Reader in order to complete all of our new patient forms. Download the free Adobe Reader at http://get.adobe.com/reader/

A note for Mac users: Please DO NOT use the “Preview” application when completing these forms. Due to incompatibility issues, these forms will appear blank on other computers. Please ONLY use Adobe Reader.

Step One

Download Your New Patient Forms

Every patient who comes to RMA of 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.

Step Two

Your Previous Medical Records

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 provider 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.

Step Three

Additional Consent and Policy Forms

We’ll provide you with several forms during your first consultation at RMA of Southern California. However, if you’d like to speed up the registration process you may download and complete the following forms in advance.

Please download and complete all of the forms listed below, and then return them to our office one to two weeks before your new patient consultation.

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 of 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 hour 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 of Southern California without contacting us, we will bill you for the visit.

Cancellation Reschedule Policy

After three appointment cancellations, RMA of 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.