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  • Permission to Contact Insurance Carrier and Agreement of Financial Responsibility
  • AUTHORIZATION FOR COASTAL FERTILITY MEDICAL CENTER / REPRODUCTIVE SPECIALTY LABS TO CONTACT MY INSURANCE CARRIER
  • I authorize Coastal Fertility Medical Center/Reproductive Specialty Labs to inquire on my behalf, regarding information about my benefits and coverage. I also authorize the release of any medical or other information necessary to process my insurance claim(s)

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  • AGREEMENT OF FINANCIAL RESPONSIBILITY and AUTHORIZATION TO BILL DESIGNATED INSURANCE CARRIER(S)
  • I authorize Coastal Fertility Medical Center (CFMC) / Reproductive Specialty Labs (RSL) to bill my insurance carrier(s), and I also authorize benefits to be paid directly to CFMC and RSL. If my insurance carrier, for any reason, will not cover a particular treatment, medication, or procedure, either in full or part, I understand, and agree it is my responsibility to remit payment in full, unless prior written arrangements have been made with the CFMC/RSL billing department

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  • **SIGN BELOW ONLY IF YOU DO NOT WANT US TO CONTACT YOUR INSURANCE CARRIER**
  • DO NOT CONTACT INSURANCE CARRIER
  • I wish to be a cash account. PLEASE DO NOT CONTACT MY INSURANCE CARRIER FOR ANY REASON, unless I request (in writing) for you to do so.

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30% OFF All Treatments IVF, IUI, ICSI etc.

Take advantage of this great deal while it lasts.

Promotion is valid 7/1 - 7/31/2020. Secure your discounted service price for 12 months by paying a $3,000 deposit during this timeframe. To see all promotion rules click here

Egg Freezing Special: Only $5,988!*

Preserve your fertility today and take control of your future!

Schedule a complimentary (virtual) egg freezing consultation, including a free ultrasound, with one of our fertility experts.

*Promotion is valid 7/1 - 7/31/2020. Secure your discounted cycle price for 12 months by paying a $3,000 deposit during this timeframe. To see all promotion rules click here