Mailing Forms

It is extremely important that we receive your Initial Appointment Forms via mail or fax as early as possible prior to your initial appointment.

Once you complete the forms, we request that you mail them prior to your first appointment to: 

    Angie Champion
    Honea, Houserman, Long and Allemand, P.C.
    2006 Brookwood Medical Center Drive
    Suite 508
    Birmingham, AL  35209

OR fax the completed forms to Angie Champion at 205-870-0698

Please be sure to download and print the Medical Release Form and send this form to any of your current physicians to release your records to us.  Be sure to put the date of your appointment on the release form so they can proceed with release of your records to us prior to your first appointment.

Medical Release Form (pdf file for download and printing only)

Please print the New Patient Checklist in order to keep track of the forms you have completed as well as information to bring to your first appointment. Please make sure you complete all forms before you mail or fax them to the office.
  
New Patient Checklist (pdf file for download and printing only)

The Initial Appointment Forms below should be completed and either mailed or faxed to us as early as possible to begin your chart prior to your first appointment.  Should you have problems with this page please e-mail us at artprogram2006@aol.com. 

Below is additional information that may be useful to you prior to and during your care at the ART Fertility Program. You may download and print these for your information only.

Cost and Insurance Guide

Patient Services and Billing Guide

Telephone Communication Guide
(pdf files for download and printing only)