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IVF and Egg donation

    I hereby give consent to the processing of my personal data and I hereby declare that I have provided complete and truthful information in this questionnaire. I am aware of the fact that the clinic cannot be held responsible for the damages caused by incomplete or inaccurate information provided by others.

    Personal data

    Female

    Male

    Contact details

    Phenotype information

    Female

    Male

    Anamnesis – Female

    Family

    General Health

    Gynaecological History

    Infertility History

    Anamnesis – Male

    Family

    General Health