New Patient Packet
Fertility & Surgical Associates of California provides state-of-the-art, personalized reproductive care in a friendly and intimate office setting. We are fortunate to have experienced tremendous growth since we opened our doors in 1999, yet we care for our patients today, the same way we cared for the first patient who walked through our doors – with respect and compassion.
We are constantly striving to improve each aspect of our patient care. This facilitates optimal tailoring of the medication regimen, laboratory techniques, and embryo transfer for each patient. A direct result of this attention to detail and constant review of protocol is our ever-increasing pregnancy rate. Our team-oriented approach is to offer the most time and cost-effective treatment for your particular situation. The physicians at FSAC have advanced, subspecialty training in reproductive medicine, and an outstanding proven track record in all areas of infertility diagnosis and treatment. FSAC comprehensively reviews each IVF cycle with the entire FSAC team (physicians, embryologists, physician assistants, and registered nurses). The physicians at FSAC are recognized as leaders in their field and have received numerous awards from the American Society for Reproductive Medicine and the media for their contributions to reproductive care.
Through our collaboration and research with other leading fertility programs worldwide, we offer the latest and most successful treatments available. FSAC is the only program in the area with an onsite in-vitro fertilization (IVF) laboratory and Ph.D. embryologist, allowing us to provide stateof-the-art laboratory support to achieve the highest pregnancy rates possible.
Our intimate office practice provides the emotional support, which patients need during treatment. Every phone call during office hours is answered by one of our professional staff members. After office hours, patients have communication access to their physician through a 24-hour answering service. To ensure you receive the highest level of comprehensive care during this difficult time, we also provide a “Patient Liaison Network” and access to experienced infertility psychologists, certified acupuncturists, eastern medicine specialists, and licensed donor/surrogate agencies, if you desire.
To best assist you and make your visit as productive as possible, please complete the following forms before your visit:
Or download individual forms below:
✓ Patient Information Form
✓ Patient Insurance Information Form
✓ Eligibility Guarantee Form
✓ Assignment of Benefits, Authorization and Financial Statement
✓ HIPAA Privacy Rule Individual Consent Agreement
✓ Comprehensive History Form
✓ Financial Policy (please review and initial each item)
✓ Patient Rights and Responsibilities
✓ Notice of Privacy Practices
✓ Medical Records Release Form
NOTE – Make sure to bring all medical records, hysterosalpingogram (HSG) films, operative reports, and clinic notes prior to your visit. Although not required, it is highly recommended that both partners be present at the initial consultation (if applicable). Please feel free to list your questions/concerns as you read our materials, and we will be happy to discuss them with you on your visit to FSAC. As a courtesy to patients on our waiting list, we ask you to inform us at least one week prior to your appointment if you are unable to attend.
We look forward to meeting with you. Please do not hesitate to contact our office with questions.
The Staff at Fertility & Surgical Associates of California