New Patient Forms
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New Patient Forms

At the New Hope Center, we understand every patient's treatment needs are specific to that individual (or couple), and it would be impossible to predict the exact procedures and services required, without first meeting with a physician to develop a treatment plan.

Informational Forms

Welcome Letter Click to Download
Return Call Policy & Contact List Click to Download
Patient Accounts Policy Click to Download
Lab Tests-Turnaround Times Click to Download
HSG Referral Form Click to Download

Forms Required to be Completed and Submitted

Medical Records Release
- For New Hope to get patients prior records
Complete and Submit
Consent for Investigation of Pharmacy Benefits Complete and submit
Booking Policies Complete and submit
Female History Form Complete and submit
Male History Form Complete and submit
NHC Financial Policy Statements Complete and submit
NHC Credit Card Authorization Form Complete and submit
NHC Cash Payment Agreement
- For "cash" patients (non- insurance covered patients)
Complete and submit
2013-Tricare Advance Notice
- ONLY applicable to patients with TRICARE insurance.
Review, sign and submit
Tricare Request for Non-Covered Services
- ONLY applicable to patients with TRICARE insurance.
Complete and submit
Compassionate Care Enrollment Form Review, sign and submit