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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