The First in Vitro Fertilization Program in North Florida and South Georgia.
Advanced Technology
with Individual and
Personal Care
Phone: 800. 777. 4831
Office Locations in
North Florida & Virginia
3627 University Blvd. South
Suite 450 Jacksonville, FL 32216
1681 Eagle Harbor Pkwy.
Orange Park, FL 32001
Lewis Gale Hospital, 1900 Electric Rd.
Salem, VA 24153
Patient Forms
We make several of our patient information forms available on line. It will greatly facilitate your appointment if you download and complete these forms prior to your first appointment.
- New Patient Letter
- Patient Information
- Sheet Financial Arrangement
- Consent for Treatment
- Patient History Addendum
- HIPAA Notice of Privacy Practices
- HIPAA Acknowledgement
- Infertility History Packet
- Medical Records Release Form Florida
- Egg Donor Application
- IVF, ART Informed Consent
Southwest Fertility Center, Roanoke, VA: Additional Forms