Financial Responsibility

I/we understand that without health insurance coverage, I/we are responsible for all IVF, IUI, FET or Donor/Carrier cycle fees of any type and full payment is due before the start of the cycle, including for blood work and ultrasounds.

Should a physician or staff member notify you that your cycles requires additional procedures, I/we give permission to charges the fees to our credit card (information listed below) once I/we have been notified.

I/we also give permission to use the same credit card to pay for fertility monitoring and/or medications.

If you are unable to use this online form, we have attached one you can download. Financial Responsibility Form

I/we acknowledge and accept these terms and conditions. I give Cardone Reproductive Medicine and Infertility, LLC, permission to use the above credit card.