New Hope. New Life. New Beginnings. A Division of MID-ATLANTIC WOMEN S CARE, PLC OFFICE POLICIES PLEASE READ CAREFULLY AND INITIAL AFTER EACH.

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1 New Hope. New Life. New Beginnings. A Division of MID-ATLANTIC WOMEN S CARE, PLC OFFICE POLICIES PLEASE READ CAREFULLY AND INITIAL AFTER EACH. BOOKING POLICIES Your initial consultation represents a significant amount of clinic time, which is reserved for you to see the physician, Financial Counselor, and our Clinical, IVF, or Third Party Reproductive Care Coordinator. It is for this reason we charge a $125 fee for noshows and failure to cancel within 72 hours (3-business days) of their scheduled appointment. Your follow-up visits, depending on the type and nature of the appointment, will typically range from 20 to 40 minutes of clinic time (exception is treatment plan consultations with a physician) and require 24-hour notice to cancel or reschedule. Failure to provide the required notice will result in a $25 fee. No-shows will also be charged a $25 fee. The clinic may have to suspend further appointment bookings until the fee is reconciled. Office Consultations and Other Visits: New Patient Deposit, Time Allotted for Appointments, Services to Anticipate During a Visit, etc. NEW PATIENT - DEPOSIT & METHOD OF PAYMENT: A deposit of $125 is required at the time of booking your New Patient/Initial Consultation. We accept Visa or MasterCard credit or debit card payments via phone and we do not accept checks via mail. CASH PATIENTS: A second payment is due at the completion of your initial visit for the balance of your consult fee. This amount will depend on the level of your visit, but will range from $35 to $55. Patients electing to proceed with a PAS-US (Pelvic Anatomy Ultrasound) at this same visit, will incur this additional fee and their balance payment would instead range from $385 to $405. Any laboratory-blood tests performed this day will be billed by LabCorp directly. INSURANCE PATIENTS: Patients with insurance coverage for their New Patient visit and services will be credited or refunded their deposit less any applicable co-payment, cost share, deductible, and non-covered service costs due for their visit. NEW PATIENT CONSULTATION VISIT CASH PATIENTS: Patients without health insurance (or) with an insurance plan our office does not participate with, are as sessed a deposit fee in the amount of $125, payable at the time of booking the New Patient visit, and no later than 3 business days prior to the date of the scheduled appointment. The New Hope Center accepts Visa or MasterCard credit and debit card payments, and does not accept checks via mail. At the completion of your New Patient/Initial visit, a second payment will be due for the balance of your consultation fee. This amount will depend on the level of your visit. Patients electing to proceed with a PAS-US (Pelvic Anatomy Ultrasound), or other testing (HSG, bloodwork, etc.) at the initial visit will incur additional fees accordingly. Any laboratory-blood tests performed on this day will be billed to you direct by LabCorp.

2 INSURANCE PATIENTS: Patients with a health insurance plan our office participates with, must provide their policy ID (mem ber number) and group number, in order for our staff to contact the insurance carrier and perform a verification of coverage/ benefits. Patients with a health plan that does cover their New Patient/initial visit, will be responsible for paying their specialist co-payment, cost share, plan deductible (if not met), and any non-covered service costs, at the time of their visit. Patients whose health plan does not cover their New Patient/initial visit, will be assessed a deposit fee in the amount of $125, payable no less than 3 business days prior to the date of their scheduled appointment. For this reason, our office re-quires a valid credit card number be placed on file with your account. At the completion of your visit, a second payment will be due for the balance of your consultation fee, and any additional non-covered services provided during your visit. FOLLOW-UP VISITS: Test Results: NHC office staff cannot give initial fertility test results (i.e. CD#3 or AMH labs, HSG, Endometrial Biopsy, Semen Analysis, etc.) over the phone. Once you ve completed the initial testing, and our office has received your reference laboratory/blood test results, your physician will instruct one of our staff to contact you to arrange a Test Results Visit. This appointment is typically scheduled for 20 to 30 minutes, and is strictly to review your test results. Telephone appointments cannot be booked for these appointments with the exception of out-of-town patients. If you would like the physician to prepare a recommended treatment plan for you to discuss at this same time, then you will instead require a TREATMENT PLAN CONSULTATION rather than a TEST RESULTS VISIT (see below). Consultations: Such as: Post Surgery, Next Steps, Treatment Plan, or Specific Advanced Therapies-IVF, Donor Egg, Donor Embryo Consults - range from 40 to 60 minutes: We are committed to providing you with the highest quality of patient care, which is why your physician will periodically recommend a consultation. This visit may entail outlining a new or alternate treatment plan, recommendations for surgery or additional testing, a review of recent treatment or surgical procedures, or outlining the benefits of or providing an overview of a more advanced A.R.T. treatment protocol (i.e. IVF, Donor Egg IVF, etc.). Since the physician schedules can fill-up quickly, it is important to book these appointments as soon as possible, to ensure a day/time that fits into your schedule, as well as one that is not more than a week or two out. Whenever possible, we ask that your partner (if applicable) accompany you to these appointments. Our scheduling staff will do their best to assist you in booking an appointment that accommodates your work schedule as closely as possible, whenever possible. Start of a Treatment Plan and Ultrasound Visits: When beginning a new treatment plan, such as a Natural Cycle, Clomid/Femara Cycle, or an Ovulation Induction (OI) Cycle, your first visit will include meeting with a Clinical Assistant to review and sign your treatment consent form(s) and to receive pertinent medication instructions, a baseline ultrasound performed by the ultra-sonographer or one of the physicians, and a blood draw for hormone level testing. Those patients without insurance coverage will also meet with a Financial Counselor to make payment for their services/cycle. This visit may range from ~40 to 60 minutes.

3 Patients beginning an IVF, Donor Egg, or FET cycle are typically scheduled for either a pre-cycle endometrial biopsy (or) a hysteroscopy/d&c, approximately one to two weeks prior to their cycle start. This visit will range from ~30 minutes to 90 minutes (the latter if having a hysteroscopy). Patients doing these more advanced A.R.T. cycles are also scheduled for a Baseline Visit, a few days prior to starting their medications. This visit will include several procedures/services: a baseline ultrasound and cervical cultures, a blood draw for hormone level testing, meeting with a member of the IVF team for medication teaching/instructions, a meeting with a member of our Embryology Lab team to review and sign their ART consent forms, and finally a meeting with a Financial Counselor to handle payment for the cycle services and to schedule their next appointment. This visit may range from ~50 to 90 minutes, and is patient specific. Each patient receives personalized attention at the NHC; our staff want to ensure you are comfortable with the medication instructions for your protocol, as well as having answered all of your questions pertaining to the A.R.T. consent forms you will be signing. We ask patients to allot enough time for this visit so they do not feel rushed, should the appointment run longer than expected. We greatly appreciate your patience during these visits. Follow-up treatment ultrasound visits (all cycles) - typically range from 20 to 30 minutes, are scheduled every 2 to 4 days, and will include an ultrasound, blood draw, and medication instructions. These visits are typically scheduled with an ultra-sonographer, and you may not see a physician this day. As such, should you have specific questions that need to be answered by a physician, please advise with the clinical assistant at the time of your check-in, so they can check the availability of a physician. If one is not available during your visit, either a physician or one of our clinical staff will follow-up with, within 24 hours, with this information. Should you experience symptoms which require trouble-shooting on a day that occurs between your follow-up visits, please call our office, and we can book you for a quick 10-minute appointment to be seen. ARRIVAL FOR APPOINTMENTS: The physicians and other providers do their best to stay on schedule and we ask for your cooperation to do so. If you arrive late for your appointment, your appointment with your physician will be shortened or you may be asked to reschedule. Early arrival for scheduled appointments allows for the necessary check-in/interview process in preparation for your visit with the physician or provider. For this reason, we request New Patients to arrive a minimum of 30 minutes prior to their scheduled appointment time, and all other patients (consults, follow-ups, ultrasound visits, annual exams, weight management, etc.) to arrive a minimum of 10 minutes prior to their scheduled appointment. Evaluation and Management via Phone and ; Emergency Services; and Payments & Financing TELEPHONE CALLS: Our phone lines are open Monday to Friday 8am to 4:30pm. Our telephone lines are very busy and your patience is appreciated. Please keep your messages brief and include your full name and telephone number and one of our staff will return your call as soon as possible.

4 Important: Please leave only ONE message - leaving repeated messages only increases the amount of time required for our staff to process through the messages, and may result in delaying staff s ability to return your call. *For LAB & CLINICAL CALLS: Our Clinical and IVF staff, return follow-up lab test calls after 12 noon each day. Requests received at 4:00pm or later, are handled on our next business day. Based on the days volume of calls/inquiries, staff may return your call as late as 6:30pm. For this reason, please provide our office with the best telephone number for staff to contact you, and one that staff can leave a detailed message with your requested information on voice mail, if you are unavailable to receive their call. *For PRESCRIPTION REFILLS: When calling to request a prescription refill please be certain to provide your full name, date of birth, the name of the medication, and the name and telephone number of the pharmacy you are requesting the refill be called/faxed to. Our Clinical and IVF staff address all prescription refill requests after 12 noon each day. Requests received at 4:00pm or later, are handled on our next business day. If using a local pharmacy, make certain to contact their facility directly, to inquire/confirm your prescription has been filled and is ready to be picked up. Mail order pharmacies take ~48 hours for process and delivery. These pharmacies typically charge additional fees for expedited processing and delivery requests with less than 48 hours notice. *Telephone-Evaluation & Management Services: SEE BELOW under S-Evaluation & Management Services for information and fees related to this type of service. S- Evaluation & Management Services Our staff and physician s NHC addresses are for general office communications only. For your medical safety, requests received at these general addresses must be converted to our EMR system for a secure response to be made. This transmission requires patients to access the response information using a password. While it is not common place for our specialty and physicians to practice medicine via telephone or , we do understand that some patients as a result of work schedules or living out of town, may require or request such services. While our physicians, providers, and staff do their best to accommodate patients needs/requests, this type of management does require time and work, and as a result our office charges for these evaluation and management services. Since this type of service is generally not covered by insurance plans, patients are charged and financially responsible for the fees assessed. *FEE for and Telephone E&M Services: A fee ranging from $50.00 to $ is assessed and will be charged to your credit card on file with our office. The exact fee is determined by the type and extent of evaluation and management services and the time required of the physician. For example: A request for information regarding a recommended test, such as an H.S.G., might result in a $50.00 fee, while a request to discuss or prepare a new fertility treatment plan would typically result in a $ fee. *ALTERNATIVE We highly recommend patients contact our office and schedule a face-to-face appointment with a provider to discuss their medical care, whenever possible. To assist patients in requesting, confirming and even rescheduling appointments, we offer a secure web based appointment system called demandforce.com. This system also allows our office to provide patients with appointment reminders for upcoming appointments via and text message.

5 At the time of scheduling your new patient appointment, please provide your address and cellular telephone number to our scheduling/reception staff. When doing so, you will receive an and text invitation from our office (and this system) to participate in this free service; please respond yes or confirm accordingly. This will allow you the convenience of receiving appointment reminders, as well as the ability to request or confirm appointments with our office in this fashion, even during hours that our office is closed or our phones are turned over to service. EMERGENCY SERVICES Our office is open Monday-Friday from 8am to 5pm. If you have an urgent medical concern, our office staff will contact one of the physicians during office hours. If you are in need of emergency services after office hours, call 911 or go to your nearest hospital emergency department. You should notify our office the next business day (or during business hours) of your visit to an ER. A physician will be informed, and one of our staff will contact you with the physician s instructions or orders, if your condition is/was in relation to your current treatment with our facility. FRAGRANCES Due to the sensitivity of some of our patients, we ask that you wear no fragrances such as perfume, cologne, after-shave or strongly scented lotions on the day of your appointment. PAYMENT & FINANCING for TESTING AND TREATMENT: Our office accepts payment via cash, Visa & MasterCard credit and debit cards, as well as cashier s and bank drafted checks. We require valid credit card information be kept on file with our office. This allows for easy payment of telephone and/or Evaluation & Management Services (if/when provided), as well as outstanding balances for unpaid co-payments or cost share. You will be asked periodically to verify and update the card and information you have on file. To assist patients with additional funding, the NHC partners with several local banks, and three (3) online finance agencies. In addition, the C.A.R.E.S. Program is available to all cash patients, and includes discount packages for both infertility testing and treatment services. The C.A.R.E.S. Program affords patients a significant discount off the normal fee for service prices, and offers packages for Basic Infertility Testing; Clomid/Femara, Ovulation Induction, IVF, and Donor Egg IVF cycles. PAYMENT & FINANCING for TESTING AND TREATMENT: Medical services rendered- including diagnostics- are not refundable. Payment is expected at the time of service, for all patient responsible monies due for procedures performed and ser-vices rendered. Patient Name: Date:

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