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The Reproductive Medicine Group - 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

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.

Monitoring Services

Thank you for choosing The Reproductive Medicine Group for your monitoring needs. Please have your physician complete the Out of Town Referral Order From with services requested.  If the patient is going to require more than one visit to our practice, the patient will need a consult with one of our physicians before monitoring services can be performed. Once orders have been received, we will be happy to schedule an appointment at any of 4 office locations.

If the ordering facility is going to be financially responsible for the patient’s medical services, we will need the facility to complete the Credit Card Authorization form. The authorization form will need to be signed by the person financially responsible for payment of service. Please fax the completed, signed form to our billing office at (813) 676-8812.

All monitoring patients are required to sign the Out Of Town Monitoring Agreement prior to services being provided.

We look forward to seeing you at your appointment.

Monitoring Paperwork:

Patient Out of Town Monitoring Agreement 

Credit Card Authorization Form

Out of Town Referral Order Form

The Reproductive Medicine Group has four 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.