Helpful Information
New Patient Forms
Prior to scheduling an initial appointment with RMA, 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 that we can make
effective use of your time with us. Please complete the following forms and fax them to 973-290-8370 at least 1-2 weeks prior to your appointment:
PATIENT PRIVACY
RECORD RELEASE FORM
MEDICAL INTAKE FORM
DEMOGRAPHICS FORM
SUMMARY HISTORY FORM
E-MAIL CONSENT FORM
DECLINATION OF GENETIC COUNSELING FORM- PLEASE COMPLETE IF YOU ARE DECLINING GENETIC COUNSELING
Existing patients,
click here to
access RMA's e-learning website
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 RMA. To ensure every patient is satisfied, here at RMA, we have developed guidelines for canceling and rescheduling new patient appointments. Please review the following and call the patient liaison department with any questions:
Cancellation Policy
If it becomes necessary for you to cancel your appointment, we require at least 48 hours notice, so that we can contact other patients who may be able to take your scheduled appointment. If you do not contact us, RMA can bill you for the missed visit.
Cancel/Reschedule Policy
If you have cancelled and rescheduled your appointment three times, RMA 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.
|