New Fertility Patient Forms

If you are new to our practice, please review important practice information on our Getting Started section.

You can save time on the day of your appointment by printing and filling out our Infertility Evaluation and our New Patient Form (below) and bringing them both to your first appointment. In addition, to save a tremendous amount of time and expense during your treatment, please bring your medical records from your referring physician and any relevant x-rays from the hospital at which they were performed. To do this, complete a Consent To Release Medical Records below and take it to your doctor or hospital.

To schedule an appointment for a semen analysis (sperm count) or other male infertility test, please click here for instructions.

Fertility Patient Forms

Download and complete the forms below and bring them to your first appointment.

To print all forms at one time, you can click here: New Patient Forms Bundle.

To print individual forms, please click the desired form below.

New Patient Forms Bundle

New Patient Registration Form

Infertility Evaluation Form

Patient Contact and Authorization

Consent to Release Medical Records

Semen Analysis Instructions

Media Release

Genetic Carrier Screening

Consent to Release Medical Information Intended Parent(s) & Carrier

Fertility Associates of Memphis is committed to keeping all of your information confidential. In order to provide you with optimal care, please read our HIPAA PRIVACY NOTICE .

Fertility Associates of Memphis Hours & Clinic Information

Visits for ultrasound and blood tests will be scheduled on an individual basis and may fall outside these hours. There are no regular clinic hours on the weekends, holidays or evenings.

Important Phone Numbers*

Main Office Number 901-747-BABY (2229)
Fax Number: 901-747-4446

For Emergencies After Hours: 901-747-2229

Our Clinic Address

80 Humphreys Center
Suite 307
Memphis, TN 38120

Our office is located at Suite 307, 80 Humphreys Center located on the Baptist Hospital Campus. This is in East Memphis just off the Walnut Grove exit of Interstate 240.

Click here to Contact Our Office