New Patient Forms

NEW PATIENT FORMS

Prior to your initial appointment with RMANJ, all patients must provide medical records specific to their care, as well as other written information. This allows our team to review the information before your visit so we can make your time with us the most productive and effective as we can. New patient forms can be downloaded directly from our site.

Please complete and deliver the following forms at least 1-2 weeks prior to your appointment. They may be faxed to 973-290-8370 or dropped off in person at any RMANJ location. If you would like to send them electronically, please contact our patient liaison team for a secure email link at 973-656-2089.

Please note you may be required to download Adobe Reader to complete our new patient forms. You can download the free Adobe Reader application at http://get.adobe.com/reader/

Note for Mac users: Please DO NOT use the “Preview” application to complete these forms, as an incompatibility causes the forms to be blank when opened on other computers. Please ONLY use Adobe Reader.

STEP 1

DOWNLOAD YOUR NEW PATIENT FORMS

Each patient who visits RMANJ is directed to complete and submit a medical intake form. These medical histories allow our physicians to make the most accurate assessments of your fertility status and devise the most appropriate treatment plans. Please select the intake form that most accurately reflects you as a patient. If you are seeking our services as a couple, each partner in the couple must complete his or her own intake form.

Please complete the appropriate forms and return them to our office 1-2 weeks before your new patient appointment. They may be faxed to 973-290-8370 or dropped off in person at any of the following office locations: Basking Ridge, Eatontown, Englewood, Morristown, Somerset, or West Orange. If you would like to send them electronically, please contact our patient liaison team for a secure email link at 973-656-2089.

STEP 2

GETTING YOUR PREVIOUS MEDICAL RELEASE RECORDS

Please complete the provided medical record release and send to your OB/GYN, urologist, previous fertility center or other medical provider to request your medical records.

We request a copy of your previous medical records to be forwarded to our office 1-2 weeks before your new patient appointment. They may be faxed to 973-290-8370 or dropped off in person at any of the following office locations: Basking Ridge, Eatontown, Englewood, Morristown, Somerset, or West Orange. If you would like to send them electronically, please contact our patient liaison team for a secure email link at 973-656-2089.

STEP 3

ADDITIONAL CONSENT AND POLICY FORMS

These additional forms will be provided to you upon arrival at your new patient appointment. To assist in the efficiency during registration, you may elect to complete these forms below in advance.

Please complete all forms and return them to our office 1-2 weeks before your new patient appointment. They may be faxed to 973-290-8370 or dropped off in person at any of the following office locations: Basking Ridge, Eatontown, Englewood, Morristown, Somerset, or West Orange. If you would like to send them electronically, please contact our patient liaison team for a secure email link at 973-6562089.

CANCELLATION POLICY

As you know, waiting for an appointment to begin fertility treatment can be stressful, so we ask you to be considerate of other patients who are waiting for their appointment with RMANJ. To ensure every patient is satisfied, here at RMANJ, we have developed guidelines for canceling and rescheduling new patient appointments. Please review the following and call the patient liaison department at 973-656-2089 with any questions: If it becomes necessary for you to cancel your appointment, we require at least 48 hour notice, so that we can contact other patients who may be able to take your scheduled appointment. If you do not contact us, RMANJ can bill you for the missed visit.

CANCELLATION RESCHEDULE POLICY

If you have cancelled your appointment three times, RMANJ will ask you to complete a Credit Card Authorization Form for payment. This will ensure us of your commitment to your next rescheduled visit. You will be charged for the initial consultation fee and when you come in for your consultation, you will be reimbursed this fee minus your co-pay.