First Appointment Forms

Please complete these forms and bring to your first appointment.

Patient Demographics

Female Patient History

Male History (if applicable)

Medical Records Release

It is important for us to have you and your partner’s (if applicable) past medical records at the time of your first visit. If you cannot bring your records at the time of your first visit, we kindly ask that you and your partner (if applicable) complete and fax back your medical record release form. Please fax this information to (513) 585-3098.

Visit our First Appointment page to learn more.

Donor Profile Forms

Female and male donors please complete the below form and email to Damita Mason at Damita.Mason@uc.edu.  If you have any questions please contact our office at (513) 585-2355. 

FemaleDonorForm (right click on link to download form)

MaleDonorForm (right click on link to download form)

We are committed to working with each individual patient or couple to research and understand the many options available for financing infertility treatment.
UC Health Reproductive Medicine Research (RMR) is the research center serving the Division of Reproductive Endocrinology and Infertility in Department of Obstetrics and Gynecology at the University of Cincinnati.