Forms and Downloads
To schedule an initial consultation, please fill out our New Appointment Form. Newsletter Newsletter sign up form – Complete this form to sign up for the CNY Fertility newsletter, which is delivered via email. Please don’t hesitate to call us if you have any questions or challenges. We are here to help you so call us toll free at 1-800-539-9870. We have staff members ready to assist you. Most links below are down-loadable PDF files. If you don’t have Adobe Reader installed on your computer you will need to first download this free program, then you can easily view the PDF files. Click here if you need Adobe Reader. Once Adobe Reader is on your computer all you need to do is click on the link. For Patients Patient Demographic Form – 1 page. This authorization form gives us permission to obtain the necessary medical files which may be helpful in your diagnosis. IUI Consent Form – 4 pages. This authorization form is needed for an Intrauterine Insemination procedure. IVF Consent Form – 8 pages. This consent form contains important concerning In Vitro Fertilization procedures. FET Consent Form – 3 pages. This authorization form pertains to the thaw and transfer of frozen embryos. Embryo Biopsy Consent Form – 2 pages. This consent form pertains to participation in an Embryo Biopsy procedure for the purpose of Preimplantation Genetic Diagnosis (PGD) in association with your In Vitro Fertilization (IVF) procedure. Clients HIPAA Consent Form – 2 pages. This authorization form pertains to use and disclosure of health information for treatment, payment or healthcare operations. HIPAA Consent to Release Form – 2 pages. This authorization form permits CNY Fertility Center to send protected health information to another facility/doctor, or allows a patient to receive their own protected health information. HIPAA PGD Reprogenetics – 1 page. This authorization form permits CNY Fertility Center to disclose health information to Reprogenetics for the purpose of performing a Preimplantation Genetic Diagnosis (PGD) procedure and resulting pregnancy and childbirth follow-up. Oocyte Cryopreservation Consent Semen Cryopreservation Consent Authorization for Operation or Procedure – Male Invasive Procedure Operative Consent Consent to Transfer Cyropreserved Reproductive Tissue Consent to Transfer Specimens to Patient Possession For Donors eIVF Donor Portal - This link will take you to our Donor Portal. Our Donor database is password protected, please contact Kari Gardner for your own personal and customized login information. You will need this login to begin your journey toward becoming a donor with CNY Fertility Center. We are here to help make this experience as easy as possible so don’t hesitate to contact us. You can phone the Syracuse Office by calling toll free 800.539.9870 or email Kari at kgardner@cnyfertility.com. Informed Consent to Donate Embryos – this authorization form pertains to those donors that consent to donate their embryos.
For Recipients HIPAA Consent Form – 2 pages. This authorization form pertains to use and disclosure of health information for treatment, payment or healthcare operations. Demographic Sheet – 1 page. This authorization form gives us permission to obtain the necessary medical files which may be helpful in your diagnosis. Recipient Profile for Donor Selection – 1 page. This will help us understand the characteristics you are looking for in a donor Informed Consent for Recipient of Donated Embryos – This form pertains to recipients that receive donated embryos. Syracuse Information Syracuse Contact Information – 1 page. This is a list of Oocyte Donor Coordinators located in our Syracuse Office. Syracuse Recipient Check List – 1 page. This is a list of all paperwork that needs to be forwarded to the Syracuse Office prior to your initial consultation. Albany Information Albany Contact Information – 1 page. This is a list of Oocyte Donor Coordinators located in our Albany Office. Albany Recipient Check List – 1 page. This is a list of all paperwork that needs to be forwarded to the Albany Office prior to your initial consultation. General Forms HIPAA Privacy Notice – 6 pages. This document describes how information about you can be used and disclosed and how you can get access to this information. Typical IVF Calendar – 1 page. This sheet represents a typical IVF timeline based on a 28-day menstrual cycle. Actual dates of medication injections, ultrasounds, blood tests, egg retrieval, embryo transfer and such will vary from patient to patient and is dependant upon many variables. This sheet is only a general reference, but it is helpful in knowing what you should expect. |
 
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New Appointment Form