Swords New Patient Form 2024

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Privacy Policy

I have read and understood the Sims IVF Privacy Policy and I agree to the processing of my personal data as per this policy. I am aware that I can contact dpo@virtushealth.ie if I have any queries regarding the processing of my personal data or if I wish to withdraw consent for this processing.

General Information

General information cont.

BMI and Height information is required. This information will be re-confirmed in Clinic. Please enter weight in stone or kg.

Previous Treatment

Your Partner

Your Partner

Female Partner Previous Treatment


Your records are considered confidential and will not be released without your consent and signature.

I hereby authorise the Sims Fertility Clinic to release information to my GP and myself.