IVF Patient FormsPatient 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.

New Patients

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.

New Patient Complete Registration Packet

Formulario de Registro de Pacientes Completo

Individual Forms

New Patient Registration Form

Formulario de Registro de Pacientes

Patient Rights & Responsibilities

Derechos y Responsabilidades del Paciente

Privacy & Financial Agreement

Acuerdo Financiero y de Privacidad

Patient-Physician Arbitration Agreement

Acuerdo de Arbitraje Médico-Paciente

New Patient Intake Form

Formulario de Admisión de Pacientes

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.

To request a Specimen Kit, please print out this form.

Directions to our office Please click here to get directions to either our Fountain Valley or Fullerton offices.

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Institute of Excellence

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West Coast Fertility awarded Institute of Excellence by Aetna Healthcare. Read more

Finance Your Fertility Treatment

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Financing solutions with low monthly payments. Apply today with Prosper Lending and New Life Fertility Finance

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Egg Freezing Special in Orange County

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Egg Freezing Special Pricing

$300 Rebate Offer*

Free Second Opinion for Failed Fertility Treatments

*Rebate for cash patients who complete IVF within 90 days. This helps cover initial consultation and ultrasound fee.
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