Patient Forms

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Patient Forms

The staff at the Reproductive Medicine Group has compiled a number of patient forms and useful information for our patients to read and complete in the privacy of their own home. Should you be asked to complete a form by our staff, you will be able to find it in this section. To view these forms, you will need an Adobe Reader installed on your computer. If you do not have the Adobe Reader, you can download the latest version by clicking on this link redirecting you to Adobe and following the set of instructions.

For Our New Patients:

Notice of Privacy Practices

For Our Current Patient Forms

Well Woman Exam:

Interval Gynecologic History Form

IVF Consent Paperwork:

IVF Consent Form

PGD / PGS Consent Form

Medical Records Release or Request:

Release of PHI Form

Important Information For Our New Patients

If you are a new patient you must first complete New Patient Forms before you schedule an appointment. Couples who are not yet established patients at The Reproductive Medicine Group can schedule a semen analysis and/or hysterosalpingogram by contacting any of our four offices.  A referral from a gynecologist, primary care provider, internist or family doctor is necessary for this testing if you have NOT been seen by a physician of The Reproductive Medicine Group.

 

 If you do NOT wish to delay your testing and treatment, simply schedule a new patient appointment and one of our physicians will order your testing.

The Reproductive Medicine Group has 4 convenient locations:

North Tampa: 5245 E. Fletcher Ave. Ste 1, Tampa, FL 813-914-7304

South Tampa: 2919 Swann Ave. Ste 305, Tampa, FL 813-870-3553

Brandon: 612 Medical Care Dr., Brandon, FL 813-661-9114

Clearwater: 3165 McMullen Booth Rd. F-2, Clearwater, FL 727-724-0702

Ultrasound (sonograms), semen analysis, blood draws and IUI with freshly collected sperm, are performed at all 4 of our locations Monday – Friday by appointment only. On weekends, ultrasounds, blood draws and inseminations are performed by appointment only in the mornings at our North Tampa location. Services offered exclusively at our North Tampa office include hysterosalpingograms (HSG’s), inseminations using donor sperm and frozen sperm. IVF egg retrieval and embryo transfer are performed at the RMG/IVF Surgery Center adjacent to our North Tampa office.