New Patient Forms

Medically reviewed by Norbert Gleicher, MD, FACOG, FACS - Written by CHR Staff - Updated on Jan 22, 2021

Before Your 1st Appointment

Below are the forms that we need from you before your first appointment. Please complete them as best you can, and send them back to our receptionists. If you have not made an appointment for your initial consultation, please do so before you fill out the forms below. You can make an appointment by calling our front desk at 212-994-4400.

  1. HIPAA Notice
  2. Registration & Financial Forms
  3. Cancellation Policy
  4. New Patient Questionnaire (online form or PDF)
  5. New Patient Survey

If you have any questions about the forms, please contact our receptionists at 212-994-4400.

Norbert Gleicher, MD, FACOG, FACS

Norbert Gleicher, MD, FACOG, FACS

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.