If you are a new or prospective patient of the Palo Alto Medical Foundation's (PAMF) Reproductive Endocrinology and Fertility Clinic, please download and print the following letters and forms. Please fax the completed forms to two to three days prior to your first appointment to one of the following fax numbers:

• Portola Valley Women's Health Center: 650-853-2237


• Fremont Center: 510-498-2133

If you are unable to fax the forms prior to your appointment, please bring your completed forms with you to the appointment. The physicians -- Dr. Swiersz, Dr. Tazuke, and Dr. Dobson -- will review the completed forms prior to your appointment to familiarize themselves with your health and reproductive history.

Portola Valley Forms:

• Letter to New Patients
  
• Sample Insurance Letter
  
• Male Patient Questionnaire
  
• Female Patient Questionnaire
  
• Preconception Genetic Screening Questionnaire
  (Both partners should complete separate Genetic Screening Questionnaires.)

Fremont Center Forms

• Letter to New Patients


• Sample Insurance Letter


• Male Patient Questionnaire


• Female Patient Questionnaire


• Preconception Genetic Screening Questionnaire

(Both partners should complete separate Genetic Screening Questionnaires.)

Last reviewed December 2007

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