Prior to your initial consultation, please review and complete the following information:
HIPAA is the federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs. Please review our office’s HIPAA policy in advance of your first appointment.
Initial Medical History
You will enter your medical history and that of your partner through our patient portal. At the time you make an appointment, we will provide you with instructions on how to access our patient portal. Please complete all questions to your best ability prior to your first appointment at Michigan Reproductive Medicine. Our physicians review this information prior to meeting with you.
Medical Records Request to Release Patient Information TO Michigan Reproductive Medicine
Give to any health care provider or hospital with records that may be needed for evaluation or treatment at Michigan Reproductive Medicine.
These forms can be completed on your computer and sent to us by e-mail, snail mail, or fax:
- Email: Forms@MiReproductiveMedicine.com
- Fax: 248-593-5925
- Snail mail: Michigan Reproductive Medicine, 41000 Woodward Ave, Suite 100 East, Bloomfield Hills, MI 48304-5130