Please choose the appropriate form(s) below to assist us in getting to know you. They will open a PDF file. Please print and complete. You are welcome to fax in the forms at 952-820-3080 prior to your first visit. Please bring in any information that may help us to know your condition, such as medical test results, previous infertility treatments summary, etc….

Patient’s Health History Forms

1. Health History Forms (4 pages): ALL patients must complete these forms prior to their first visit.

2. Women Fertility Patient Forms (2 pages): these forms need to be completed in addition to the Health History Forms. Download the Women’s Fertility Forms.

3. Male Fertility Patient Form: this form needs to be completed in addition to the Health History Form.

Health Insurance/ Claim Information Forms

Please complete the appropriate form in addition to the Health History Forms if insurance billing is going to be used.

4. Personal Health Insurance Information Form

5. Auto Accident/ Work Comp Claim Information Form

Other Forms

6. Credit Card Authorization Form

7. Health Information Release Form

8. BBT Charting Form