FORM – Self-disclosure for fertility treatment

Please take the time to answer the following questions and send us the form in good time – preferably five days before your appointment with us at the latest. Then your doctor can personally prepare for your visit.

Of course, it is not a problem if you are unable to answer all the questions. Please fill in these fields with a question mark (?). We use your data exclusively for treatment and we will not pass them on to third parties. The form is encrypted before being sent via the Internet.