3 minutes to complete
A person who is of legal age and has the mental capacity to understand the information given as well as the consequences of the procedure can fill an IVF consent form.
Full name
Date of birth
Address
Phone number
Email address
What is your chosen treatment?
Are you aware of the estimated cost of your chosen treatment?
Are you aware of the risks that are associated with the treatment you have chosen such as risks associated with the use of fertility drugs, surgical procedures, the use of assisted reproductive technologies (ART) etc.?
Have you been diagnosed with any medical conditions that may affect your fertility?
Are you taking any medication that may affect your fertility?
Do you have any allergies that may affect your fertility treatment?
Do you have any religious or spiritual beliefs that may affect your fertility treatment?
Do you have any other concerns that you would like to discuss with us prior to treatment?
Your signature
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Uses end-to-end encryption technology that allows users to create survey forms where data is secure and private. UI looks very beautiful.
For our NGO, data privacy is everything—and this platform nails it. It keeps personal info fully protected while letting us design beautiful, chat-like surveys that increase engagement. Team collaboration features sealed the deal.
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BlockSurvey is very user-friendly with amazing customization options. It makes capturing data simple and secure. While the Web3 space still has room to mature, the platform itself is smooth and intuitive.
Creating surveys with BlockSurvey has been a breeze. The drag-and-drop interface is intuitive, and we’re able to collect data anonymously and securely—without intermediaries. It’s interactive, friendly, and encourages high participation while protecting user privacy. The reports are solid, and we’ve used it confidently for internal and external feedback.
Few tools combine data confidentiality and form aesthetics like this one. The conversational design improved my response rate by 43%, and the webhook integrations made syncing to our CRM effortless. I also love how responsive and community-driven the support team is.
I think BlockSurvey is good for short and long surveys. What I find the best is the fact that there are so many templates I can use and customize.
