Before your first visit
To save time, complete these forms and forward them to our office before your first appointment. Our fax number and mailing address are provided below.
Please bring a copy of these documents to your appointment.
- Medical History Questionnaire (pdf)
- Consent to Release Information (pdf)
- Genetic Screening Questionnaire (pdf)
- Patient Records Release Form (pdf)
- Authorization to Email Protected Health Information (pdf)
- Copy of your insurance card and pharmacy card
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.
Sign up or log in »
Medical records release
Use this release form to obtain a copy of your records from your medical provider(s). Please complete the form in its entirety, sign and date, and send it to us via fax or mail (see contact information below).
Patient Records Release Form (pdf)
Sending us your forms
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