New Patient Forms

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

• 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.)

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