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IVF New England Patient Forms

Administrative Forms

Name Change Form
Please mail completed name change form with a copy of your current photo ID showing your new name to IVF New England - Attention: Patient Services, 450 Bedford Street, Ste 1000, Lexington, MA 02420. ACCEPTABLE PHOTO IDS: Any non-expired photo ID such as a driver's license, military ID or passport.

 

Billing Forms

Recurring Credit Card Billing for Cryopreserved Specimens

 

General Consent Forms

Genetic Screening Consent
Rubella Waiver
Consent for Treatment Without Varicella Immunity

 

IUI (Intrauterine Insemination)

Ovulation and Intrauterine Insemination Treatment Guide Booklet

 

IVF (In Vitro Fertilization)

Assisted Reproduction Consent for Treatment Guide Book (102014)
Embryo Cryopreservation Storage Fee Information
Oocyte (Egg) Cryopreservation and Storage Fee Information

 

***All Patient Consent Forms***

All treatment consent forms (IUI, IVF, Egg Freezing, Laboratory and more) can be found on Boston IVF's website. In 2014, IVF New England and Boston IVF – two of the country’s most experienced fertility centers – began a close clinical partnership in effort to better streamline innovative treatments and operational protocols.

To Request Your IVF New England Medical Record

To request a copy (or copies*) of your medical record please complete the attached form and include the required information. Medical records are mailed to a patient within ten (10) business days from the date of receipt of this completed request form. The first copy of a patient’s medical record is released free of charge. * A fee of 25 cents per page, payable in advance, is charged for additional copies. It is recommended that patients have their medical record sent to their address and make any additional copies as needed for your physicians. Note: IVF New England cannot release records sent to IVF New England from another doctor’s office.

Medical Record Request Form from IVFNE

If you are being discharged from IVF New England to your obstetrician (OB) for pre-natal care we will automatically send a copy of your obstetrical ultrasound report, a letter outlining your treatment at IVF New England and your Patient Checklist to your OB. Some OBs may also want copies of your infectious disease and genetic test results. To request copies of these additional records please fill out the Medical Record Release Form and fax it to our Medical Records Department at 781 674-1520.