NFC - New Patient Forms

New Patient Forms
If you decide to become a patient of NFC, please fill out our new patient forms prior to making an appointment. There are several ways of completing this process:

Fill out and submit the five patient forms (2 for male; 3 for female) on our secure web page. The links to these secure pages are at the bottom of this page.
Request our New Patient Packet by either calling NFC at (615) 321-4740, or e-mailing NFC (click on the "contact NFC" button above). Complete the forms once you receive them, and mail them back to NFC.
You may also open the forms online and print them. Complete the forms and mail them to NFC.

Once your completed forms are received by NFC, our New Patient Coordinator will contact you promptly to schedule a new patient appointment.

Please note: If you are completing the information on the web page you will still need to mail us your medical records from your previous physicians and a copy of the front and back of your insurance card. See the link below for the Medical Records Release Form that you may print and send to your previous physicians.

Your first office visit will include:

Consultation
Review of Previous Medical Records
History and Physical Exam
Lab tests and other procedures (as needed)

Payment

Consultation fees are $110 to $425. There will be charges for both of you.

Lab tests, ultrasounds, and other procedures will result in additional fees.

Your insurance will be verified prior to your appointment.

If your problem is not related to infertility, please fill out these information forms to the best of your ability and knowledge. The information provided will help us to provide you with the best care.

Note: Please remember that all five forms must be completely filled out. You will receive a confirmation by email when your forms have been received and reviewed.

Male:

Female:

Release of Medical Records Form Print this form and send it to your previous physicians so that NFC may receive your medical records.

Consent Forms

You may print the following consent forms. After completing them you may either FAX them to your IVF nurse at 615-277-2455 or mail them to NFC at the address at the bottom of this webpage, to the attention of: IVF nurse.

Nashville Fertility Center 345 23rd Ave. N., Ste. 401, Nashville, TN 37203 (615)321-4740 Fax (615)320-0240