WCFC Patient Forms

Our most frequently used patient information forms are available online for your convenience. You may either save the fill-in forms on your hard drive and then complete on your computer or fill them out online, print them out and send them via email.

Please note: To view, complete and print FCC fill-in PDF forms you'll need the freely available Adobe Reader software installed on your computer. Click here for detailed instructions on how to fill-in your information on the forms. If you do not have Adobe, click here.

New Patients

To expedite the registration process for your initial visit to West Coast Fertility Center, we request you complete your registration and Medical History forms and return them by email. Also, please make a copy and bring it with you on your appointment day.

Patient Registration Form                  Patient Registration Form (Spanish)

Patient Medical History Form            Patient Medical History Form (Spanish)

Medical Records Release Form (in case of previous fertility treatment history)
If you wish Dr. Diaz to review your medical records from prior treatments, please print the enclosed records release form. Send the form or take to your doctor’s office to request a copy of your records. Bring the copy of your records on the day of your initial visit to West Coast Fertility.  Please note: It is more productive to go directly to your doctor’s office to pick up the medical records personally.