Fertility & Women's

Health Center

of Louisiana

4630 Ambassador Caffery

Suite 206

Lafayette, LA 70508

337/989-8795  voice

888/467-BABY  toll-free

337/989-8766  fax

Lafayette

Lake Charles

Alexandria

Patient Manuals and Forms

Welcome to our practice. We look forward to caring for you in the future. Prior to your initial visit to Fertility & Women's Health Center of Louisiana we may ask you to complete and return several questionnaires and/or read over our patient manuals. This will help us be more efficient with your time and enable us to concentrate on establishing a diagnosis and treatment plan for you and your partner. Please be sure to list any specific concerns  you have at the end of the questionnaire. If you would like to fax us your completed forms before your visit, please print out the Fax Cover Sheet below. Thank you very much and we look forward to meeting you!

To fill out and submit patient forms electronically, please click HERE.

To download and print patient forms to bring with you to your appointment, click on the links below:

Infertility Patient Forms

• Infertility New Patient Information Form

• Infertility Questionnaire for Women

• Infertility Questionnaire for Men

• Fax Cover Sheet

IVF Patient Forms

• IVF Program Guide

• IVF Financial Consultation for Insured Patients

• IVF Financial Consultation for Uninsured Patients

Gynecology Patient Forms

• New Patient Information Form

• New Patient Questionnaire

Patient Confidentiality Forms

• Notice of Privacy Policy for Fertility & Women’s Health Center of Louisiana, LLC (FWHCLA)

• HIPAA Authorization for Release of Information

• Notice of Privacy Policy Acknowledgement

• Consent for Purposes of Treatment, Payment, and Healthcare Operations

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Date Page Last Edited: 10/06/2008