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Fertility Questionnaire

Completing this questionnaire will provide us with the information we need to ensure you are booked with the appropriate specialist.

Questions for Female Partner

YesNo
YesNo
YesNo
YesNo

Have you ever had any of the following?

YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo