Contact

Phone

+49 89 547041-0

First appointment
Availability by phone
Mo – Thurs 7:00 a.m. – 4:00 p.m.
Friday 7:00 a.m. – 1:00 p.m.
Opening hours practice clinic
Mo, Tue & Thurs 6:45 a.m. – 3:30 p.m.
Wednesday 6:45 a.m. – 4:00 p.m.
Friday 6:45 a.m. – 1:00 p.m.

Questionnaire for the First Appointment

Fields marked with * are required.

Your inquiry

General Information – Woman

You are

General details of the partner

Do not fill this in if you are a single mum.

Are you two married?

The woman's personal information

Period / Monthly Cycle?
Do you have any known allergies?*
Are you taking any medications?
Do you or have you suffered from serious illnesses?
Do you have any significant prior surgeries?
Has the patency of the fallopian tubes been checked?
Is there a semen analysis available?
Do any of your first-degree relatives (parents, siblings) have cardiovascular diseases (heart attack, stroke, thrombosis)?
May we inform the doctors you have listed in writing about the results of your treatment?

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