We ask that you arrive at least 15 minutes before your appointment to complete all the necessary paperwork. To better serve your medical needs, we ask that you provide us with as much medical information as possible.
For your convenience, you can complete your paperwork prior to your appointment.
Your options are:
- Print and complete the forms listed below
- Using Adobe Acrobat Reader, download, fill in and print the forms below
- Request the forms to be mailed to your home
Once completed, remember to bring your forms with you to your appointment.
Patient Forms:
Additional Forms:
- Semen Production Instructions (English)
- Semen Production Form (English) (no specimen will be accepted in our lab without this form)
- Semen Production Instructions (Spanish)
- Semen Production Form (Spanish) (no se aceptará ninguna muestra en nuestro laboratorio sin este formulario)
- Medical Record Release Forms
Patient Resources
Our Patients
While some patients have known since they were young that based on their medical history, they would need fertility treatment to conceive, most patients are not prepared. For those patients who have just recently learned that they are now having or will in the future have trouble conceiving, this can be a very challenging time. Our team is here to guide you through this difficult time in your life. Island Fertility treats all types of patients who are trying to conceive as well as those who have just learned that they may have trouble conceiving in the future, including:
- Heterosexual Couples
- Same-Sex Couples
- Single Women
- Individuals and Couples Carrying Inherited Genes Disorders or Chromosomal Anomalies
We recommend seeing an infertility specialist early in your journey to parenthood. In some cases, even patients who have no trouble conceiving may require genetic testing and/or genetic counseling, especially if you have experienced a miscarriage. Cancer patients should schedule a new patient appointment as soon as you are diagnosed to have the best chance of preserving their fertility. Newly diagnosed cancer patients and patients facing medical intervention that may cause infertility are given priority scheduling and, in most cases, can be seen same-day.
Call our office to schedule a new patient appointment. You will provide some basic information to our staff for you and your partner (if applicable). You will be provided login information for our patient portal where you and your partner (if applicable) will complete your medical history. This information must be completed prior to your appointment date so that the doctor can review it with you at your appointment.
Heterosexual Couples
Heterosexual couples seeking treatment may have the option of using their own eggs and sperm for their treatment, which opens up all ranges of treatment from timed-intercourse (TI) to in vitro fertilization (IVF). Many patients in this group find that simply regulating menstrual cycles with lifestyle management or medication allows them to conceive naturally after treatment. When issues are a little more complex, there is intrauterine Insemination (IUI). When issues are even more complex, there is IVF. We offer all of these treatment options and more.
Same-Sex Couples
Female, same-sex couples often can be treated with IUI and donor sperm and may or may not require regulation of the menstrual cycle with lifestyle management or medication. For some patients, IVF is the best option medically. Some couples chose to go through IVF so that one partner may carry the baby using the eggs of the other partner.
Male, same-sex couples will have to use IVF with an egg donor and gestational carrier. Island Fertility offers all of these treatment options and more.
Single Women
Many single women chose to begin their journey to parenthood with donor sperm. Most of these patients will be successful after the regulation of the menstrual cycle with lifestyle management or medication followed by IUI. For those patients that have more challenging fertility issues, IVF with donor sperm is a good alternative. We offer all of these treatment options and more.
Individuals and Couples Carrying Inherited Genes Disorders or Chromosomal Anomalies
Cancer patients and individuals facing disease or treatments, which may impair their fertility in the future
Many diseases and disorders or their treatments have the potential to cause infertility in the future in both men and women. Newly diagnosed patients usually have a limited period of time for fertility preservation before their treatment begins. They should discuss their options with a reproductive endocrinologist as soon as possible after diagnosis. We will make same-day appointments for patients in this situation.
Cancer patients are in a unique position when it comes to their fertility options. Many cancer treatments will cause infertility or even sterility after treatment. As stated above, newly diagnosed patients should begin talking to a reproductive endocrinologist as soon as possible to ensure they have the option to preserve their fertility prior to treatment. For patients who had cancer at any point in the past, fertility treatments can help them establish a healthy pregnancy. We treat many patients in this situation successfully with both IUI and/or IVF.
Individuals and couples carrying inherited genes disorders or chromosomal anomalies
We are living in an age of amazing genetic testing options. All patients looking to conceive should have prenatal genetic testing to rule out the potential for your children inheriting hidden diseases and disorders from the egg and/or the sperm. Prenatal genetic testing is standard for all Island Fertility patients.
Healthy, young men and women who wish to preserve their options for the future
The same fertility preservation treatments that are available to patients suffering from diseases or disorders which may cause infertility are available to healthy young men and women as well. These patients can choose to preserve their fertility options for the future to help them.
Good Faith Estimate
If you are uninsured, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call our office.
Insurance
Island Fertility currently works with over 30 major insurance companies. Our staff is always working on accommodating our patients and their insurance providers. Please call our office at (631) 638-4600 to find out if your carrier is on our continuously expanding list of providers.
- 1199SEIU National Benefit Fund (through Aetna Health Plans)
- Aetna Health Inc.
- Affinity Molina/Medicaid, Child Health Plus
- Affinity/Molina Medicaid
- AgeWell New York Plans
- Beech Street, a MultiPlan Network
- MagnaCare PPO /Direct Plus (Brighten Health Plan)
- Magnacare Northwell Direct (wrap-around network)
- CenterLight Healthcare
- Cigna HealthCare of New York HMO, PPO, Open Access
- Emblem Health-Somos
- EmblemHealth Plan, Inc., (GHI)
- Healthcare Partners (Specialists only)
- Emblemhealth Plan (HIP)
- Empire HealthChoice HMO, Inc.-Prefixes - R4R, ZTO, PYO, S8Q, KCH, YXF, AZL, J2H, C4D, YKH, HPP, D9U, PTQ, EQV, VRH, VYW, L4P
- Empire HealthChoice HMO, Inc.-Federal Employee Program (Prefix R)
- Empire HealthChoice HMO, Inc.-EmpireBlue _ Northwell Direct Tier 2
- Empire HealthChoice HMO, Inc.-Blue Cross Blue Shield Global Core
- Empire Blue Cross (confirm plan with Empireblue.com)
- Empire Medicare Advantage HMO Plans (not Select Plans)
- Empire BlueCross BlueShield HealthPlus Medicaid/ Child Health Plus (Prefix JLJ)
- Empire Plan, the New York State Health Insurance Program (NYSHIP)
- Excellus Health Plan, Inc.
- Fidelis Medicaid, Child Health Plus, HealthierLife
- Healthfirst Medicaid, Child Health Plus, Essential, Personal Wellness
- Humana ChoiceCare Plans as a Wrap-Around GHI Network Access
- Humana TriCare
- MultiPlan PPO/PHCS/Limited Plan
- Oxford Freedom
- Oxford Liberty
- Partners Health Plan
- UnitedHealthcare Community Plan-Medicaid, Child Health Plus,Wellness4Me
- UnitedHealthcare of New York, Inc.-All Savers
- UnitedHealthcare of New York, Inc.-Bind Health Insurance
- UnitedHealthcare of New York, Inc.-Choice Plans
- UnitedHealthcare of New York, Inc.-Compass Plans
- UnitedHealthcare of New York, Inc.-Doctors Plan
- UnitedHealthcare of New York, Inc.-The Empire Plan/NYSHIP
- UnitedHealthcare of New York, Inc.-Heritage Plans
- UnitedHealthcare of New York, Inc.-Navigate Plans
- UnitedHealthcare of New York, Inc.-NexusACO Tier 1
- UnitedHealthcare of New York, Inc.-Options Plans
- UnitedHealthcare of New York, Inc.-Passport Connect Choice Plans
- UnitedHealthcare of New York, Inc.-Select Plans
- UnitedHealthcare of New York, Inc.-Signature Value Plans
- UnitedHealthcare of New York, Inc.-W500 Emergent Wrap
- UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
- United Healthcare Assisted Living Plan (PPO I-SNP)
- VA Community Care Network
**Disclaimer**
Insurance plan participation may change over time. While every effort is made to ensure the accuracy of this information, we recommend that you confirm participation status with your insurance carrier or practice. Please note that insurance plan participation requirements may be waived when a patient receives medical treatment in an emergency.