Patient Forms & Handouts

The following handouts are available in Adobe PDF format to download and print. If you need assistance, please contact us.

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.
Patient Policies: 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.