Patient Referral checklist

1. Patient should call the location where she would like to be seen or she could request an appointment by logging on to www.colocrm.com and click “Request an Appointment” If she requests an appointment on line a new patient coordinator will call her within 24 business hours to set up an appointment for her.
2. After her appointment is scheduled, she will receive via email paperwork form CCRM that contains medical release forms which will be used to request records from the referring primary care provider.
3. Ensure the physical examination is up to date: These tests as well as any other pertinent records we need to proceed with diagnosis and treatment.
   • Annual exam (including breast exam) and Pap test in the last 12 months.
   • Mammogram for patients over 35 years old within the last 12 months
   • Basic bloodwork TSH, Prolactin, Blood type/RH, Ruebella/Varicella titer.
   • Genetic screening- Chromosomes or ethnic screening.
   • Any infertility work-up that has already been done at the office of the primary care provider including:
   • Hysterosalpingogram or Hysterosonogram.
   • FSH, LH, E2, AMH if you have done these.
   • Semen Analysis
4. The patient may call her insurance company to check benefits for infertility diagnosis and treatment. For assistance with this she may consult the Financial/Insurance information in our new patient guide. Click here to Request new patient guide.