Female Patient Registration Form

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    Please note UK government advise couples not to conceive within 8 weeks of travel to Zika affected areas.


    Emergency Contact Detail


    Obstretic History


    Cause Of Infertility / Reason For Treatment (More than one may apply)

    Tubal disordersEndometriosisUterine ProblemsOvarian FailureAvoidance of genetic disorderNo male partnerOther


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