Patient Registration Forms for West Coast Fertility Center Orange County
Patient registration forms are available online for your convenience. You may print out the pdf registration forms, fill them out at home and bring them to your consultation appointment. You can also fax the forms to us at (714) 513-1393. Or, you can fill out the pdf registration forms online and submit them as an attachment by email to.
Please note: To view, complete and print FCC fill-in PDF forms you'll need the free 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 to install it.
To expedite the registration process for your initial visit to West Coast Fertility Center, we ask that you complete your new patient registration and medical history forms and return them by email or fax. Also, please make a copy and bring it with you on your appointment day.
Please save the registration form to your computer and open it with Adobe Reader before you work on it. Doing so will allow your information to be saved so the form can be emailed or printed without re-entering data.
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 them 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.
Medical Records Release Form (in case of previous fertility treatment history)
Please note: It is more productive to go directly to your doctor's office to pick up the medical records personally.
Directions to our office Please click here to get directions to either our Fountain Valley or Fullerton offices.