Sims IVF His & Her Fertility Test

Please complete the following form to register for the His & Her fertility test at Sims IVF

General Information







General information cont.








GP details



Your Partner









Female Patient Medical History

Please complete this form to the best of your knowledge. If there are any question you are uncertain about, do not worry. The details will be discussed with the doctor at the first appointment.

The form will take some time to complete. if you have any questions or queries, please do not hesitate to contact us.

If you have further information, medical records or otherwise, please bring them to the first appointment so that your doctor can review them.

Have you ever undergone an operation? (If so, please give details of all operations including the year).








Female medical history continued



Social History





Family History



Menstrual History










Gynaecology History








Obstetric History


Obstetric History

Please provide any information you can below










Previous Treatment



Male Partner Medical History (if applicable)





Male Partner Fertility/Andrology










Male Partner Social History





Male Partner Surgical History








Additional Comments