It's nice to meet you! Before we proceed, here are 3 important things to know:

1. This initial registration process takes about 15 minutes. We'll ask for important information. This is to ensure that our providers can accurately assess your history and come prepared for the consultation with a personalized treatment plan for you. Please set aside uninterrupted time to complete this form.

2. Fertility testing before the consult is required. We require two important tests: a blood test to check AMH and a sperm health test. We also advise genetic carrier screening. We can assist with ordering these tests after you submit this inquiry form. Completing required tests before your consultation can expedite your diagnosis and treatment process. Click here to learn more about fertility testing.

3. We take insurance for consultation. We are in the network of Premera, Regence, Anthem, BlueCross BlueShield, United Health Care (UHC), Kaiser PPO (NOT Kaiser Core), Aetna. However, all fertility treatments such as IUI, IVF, FET, Egg Freezing, are self-pay, and payment is expected at the time of service. If you don't have commercial insurance or Think Fertility is not in the network of your insurance, here is the fee for the consultation: New Patient Consultation: $350 , if in-person visits include ultrasound, would be a $100 add-on. After you submit the form, our team will follow-up via phone to schedule an appointment with our providers.

Would you like to proceed? Just click yes below to start the process!

First Name *

Last Name *

Date of birth *

Phone *

Email *

Address *

City *

State *

Postal code *

Country *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. You can reply STOP to unsubscribe at any time.

Sex Assigned at Birth *

What is your weight? (lbs) *

What is your height? (ft/in) *

Who is your insurance carrier?

What is Your Policy Number?

What is Your Group Number?

Please enter the name and date of birth of the subscriber.

Name
Date of Birth (mm/dd/yy)

What is Your Relationship Status?

Partner's First Name

Partner's Last Name

Partner's Date of Birth

Partner's assigned sex at birth

Male

Female

Partner's phone number (Do not use your phone number)

Partner's email address (Do not use your email address)

Does your partner have the same residential address as yours?

Yes

If "No", please fill in your partner's mailing address

Thank you for taking the time to complete the initial intake form! Please click the Captcha button below and then click submit!

Captcha