Patient Forms

New Patient Packet

To make the most of your visit, our physicians prefer to review your medical history prior to your first appointment. Sending your records in advance will move the process along and enable you to bypass duplicating tests. You have options to fill out electronically and print, or print and fill out by hand. Please mail or fax pages 4-20 of your new patient packet to our office before your first appointment. A fax cover sheet is included at the end of the packet.

Please bring a copy of these documents to your appointment.

– Download New Patient Packet forms
– Copy of your insurance card and pharmacy card

Fax: 314-286-2455
Mail: Please send all mail to our Central West End Location

Fertility and Reproductive Medicine Center
4444 Forest Park Ave., Suite 3100
St. Louis, MO 63110

Individual Forms (these are included in the New Patient Packet)

Medical Records Release Form

Laboratory Consent Forms

Please click on the link to download the form you need.

Receive Frozen Embryos (from an outside clinic/lab)
Transfer Frozen Embryos (to another clinic/lab)

Sperm Banking Packet (for new patients)
Release Frozen Semen (for use or transfer)
Discard Frozen Semen
Anonymous Donor Frozen Semen (discontinue storage – donate or discard)

Follow My Health patient portal

The online patient portal is a secure way to manage your health care information and communicate with your physicians at Washington University School of Medicine.
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