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Patient Forms & Handouts
The following handouts are available in Adobe PDF format to download and print. If you need assistance, please contact us.
NYU Fertility Center Forms & Handouts
- Package for New Patients: To be completed by all new patients prior to their first appointment.
- Authorization for Release of Medical Information : Must be completed if you are requesting that medical information regarding your care and treatment at NYU Fertility Center be released to another doctor, insurance, etc.
- Authorization for Release of Surgical Films: For use when requesting the ORIGINAL radiology films from NYU Fertility Center be released to your care.
- Authorization for Request of Medical Information to NYU Fertility Center: Please use this form when asking outside parties to release your medical information to your physician at NYU Fertility Center.
- Notice of Privacy Practices: This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully and then sign an acknowledgement.
- Patient Bill of Rights: We encourage you to review our Patient Bill of Rights with the expectation that observance of these rights will contribute to more effective patient care.
If you are requesting HIV-related information, you will also need to complete official New York State Department of Health Required HIV Related Consent and Authorization Forms, which can be found at http://www.health.ny.gov/diseases/aids/forms/informedconsent.htm
Patient Orientation Sessions
Any patient undergoing In Vitro Fertilization (IVF), Egg Freeze or Egg Thaw protocols at the Fertility Center at NYU Langone must attend an onsite orientation session conducted by our nursing staff before beginning a cycle. Partners are encouraged to attend this session as well. To provide additional review of the information, the orientation presentations are now available for you to review online. Please note, this availability does not eliminate the need to attend an onsite session.
Madison Women's Health & Fertility, PC
Orientations for patients of Madison Women's Health & Fertility who will be having their retrieval and/or transfer performed at our facility.
American Society for Reproductive Medicine Fact Sheets and Info Booklets
The ASRM has a series of patient handouts available, some of which are also available in Spanish, for a wide variety of reproductive topics:
- Age and Fertility
- Cancer and Fertility Preservation
- Egg Donation
- Elective Single Embryo Transfer
- Genetic Screening for Birth Defects
- Intracytoplasmic Sperm Injection (ICSI)
- Intrauterine Insemination (IUI)
- Polycystic Ovary Syndrome
- Risks of In Vitro Fertilization (IVF)
- Stress and Infertility
- Third Party Reproduction (Sperm, Egg and Embryo Donation and Surrogacy)
To read, download or print handouts on these subjects and more, please visit: http://www.asrm.org/FactSheetsandBooklets/