Patient Forms

LifeStart Fertility Center requires that all patients fill out basic forms so that we may serve you to the best of our ability. To download the forms, please acquire the password by calling LifeStart Fertility Center at 818-889-4532 during normal office hours.

Once downloaded, please print and fill out the required forms and bring them with you on your initial visit or as instructed by the staff at LifeStart Fertility Center.

Initial Visit Forms (Infertility Patients):

Infertility Patient Registration Form

Infertility History Form

Initial Visit Forms (Gynecology Patients):

Gynecology Patient Registration Form

Gynecology History Form

Medical Records Forms:

Medical Records Transfer Form

Medical Records Release Form

General Patient Forms:

OHSS Monitoring Record Form

Patient Education Forms:

Giving an Intramuscular Injection

How to Give a Subcutaneous Injection

Preparing Menopur for SubQ Injection

Preparing Pregnyl (hCG) 10,000iu

Preparing Progesterone In Oil

HIPAA Compliancy Form:

HIPAA Notice of Privacy Practices

Fertility Drug Assistance Forms:

Compassionate Care Patient Enrollment Form

First Steps Enrollment Form

For additional questions about these forms, please call us at 818-889-4532 during normal office hours or contact us by using our online form. Please do not give specific personal medical information over the Internet.

These Forms are in Adobe Acrobat PDF Format. To get the FREE PDF reader, click on the icon above.