Forms

New Patients

For your first visit, please download and complete the following forms.  Please send them in via fax (617.507.5909) or email (drchasse@perfectfertility.com) at least 24 hours prior to your visit.

Existing Patients

Authorization to Release Medical Records

  • Used to acquire medical records from another provider to provide to Dr. Chasse OR
  • Used to acquire medical records FROM Dr Chasse for yourself or another provider

Please note, most medical records are immediately available to you by logging into the patient portal.  (email and password you set up when you booked initial appointment)

Other

Notice of Privacy Practices