Forms, Registration, E-statement

Patient Forms

Click to download any of these patient forms.

• Patient Registration Form
• Female Medical Release (patient’s information goes in the top box and partner’s information in the middle block)
• Male/Partner Medical Release (the partner’s information goes in the top box and the patient’s information goes in the middle block)
• Financial and Insurance Policy
• Credit Card Policy
• HIPAA Brochure
• Egg Donor Application
• Semen Analysis
• Drug Administration

E-statement Information

You can now receive your bills from RMSCVA electronically. 
Sign up for electronic statements here: Electronic Statements 

Instructions for accessing your electronic statement: 
enter CodeID:  REPMSC01  
Access#: 2355206-1-1

 

Reproductive Medicine and Surgery Center of Virginia, PLC, 595 Martha Jefferson Drive, Suite 390, Charlottesville, VA 22911
Phone: 866-540-5190 or 434-654-8520