Kontakt

Tel. 089 547041-0

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Telefonische Erreichbarkeit
Mo - Do 7.00 - 12.00 Uhr
13.00 - 16.00 Uhr
Freitag 7.00 - 13.00 Uhr
Öffnungszeiten Praxisklinik
Montag 6.45 - 15.30 Uhr
Dienstag 6.45 - 15.30 Uhr
Mittwoch 6.45 - 16.00 Uhr
Donnerstag 6.45 - 15.30 Uhr
Freitag 6.45 - 13.00 Uhr
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Personal information »couples wishing to conceive«

In order to prepare for your visit, we would appreciate it if you could provide some answers to the following questions.

The form will be treated confidentially and only used for the purposes of your treatment.
None of the data provided will be transferred to third parties!

Max. File size for uploading: 5 MB.
Please send larger files by e-mail to: info@kinderwunschzentrum-an-der-oper.de

Our questions for her

All questions marked with * are required fields.

Period / monthly cycle*
Have you already undergone fertility treatment?*
Have you conceived as a couple in the past?*
Have you conceived with another partner in the past?*
Which one of you?*
Do you have any allergies?*
Do you take medication?*
Do you suffer from a serious illness?*
Does your partner suffer from a serious illness?*
Have you had an operation in the past?*
Has the patency of the fallopian tubes been tested?*
Has a sperm analysis been completed?*
Have either you or your partner undergone a sterilisation procedure?*
Has your partner had or do you have any fertility-limiting complications (e.g. undescended testis, testicular tumour)?*
Do you have sufficient vaccine protection (twice) against measles and rubella?*
Do you smoke?*
Does your partner smoke?*
May we inform your doctor of your treatment reports in writing?*

General information

Are you married to one another?*
How did you hear about us?

Data protection notice

We would like to alert you to the fact that all data transmitted to us is stored and processed with the help of electronic data processing. The data entered in this form will be deleted after submission. We handle the information you provide with strict confidentiality and do not transfer it to any other party. Please consult our data protection notice.

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SSL

All forms within our website use a secured connection through SSL encryption (Secure Socket Layer protocol). Your data is also sent to us via secure connection. Your data is protected during transmission by the SSL protocol and 256-bit key and cannot be viewed by third parties. The connection secured with SSL encryption can be recognized by the extension https:// in the address bar.

 

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