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Request a Free
Consultation for Consideration of Shared Risk

The IVF Shared Risk Refund Plan is available through Shady Grove Fertility Center as a financial option for patients requiring IVF who meet certain medical criteria. Complete the form below if you would like to speak with our New Patient Coordinator about our IVF Programs and your possible eligibility to participate in the IVF Shared Risk Refund Plan.

* - required information
 
First Name*
Last Name*
Address*
City*
State*  
Zip Code*
Date of Birth* / / Your Age: 
Years of Infertility*
Home Phone Number*
Work Phone Number: 
Email Address*

Have you been told you will need IVF? Yes No

 


How did you hear about the IVF
Shared Risk Refund Program?

  Select all that apply...

 

  Friend
  Physician (name: Dr )
  Radio
  Newspaper
  Internet Search
  Other (specify: )

 
 


 

Once the form is submitted, our Patient Services Coordinator will contact you to schedule a brief phone consultation.

The phone consultation does not constitute medical care but serves only as information about your possible eligibility for the optional IVF Shared Risk financing program.

  



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