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ABOUT
NORTHERN CYPRUS
ABOUT US
MEDICAL TOURISM
BLOG
PRO MAGAZINE
Gallery
CONTACT US
IVF PATIENT INFORMATION FORM
Name
*
Married
Yes
No
If yes how long?
0 / 20
Birth Control
*
Yes
No
If yes how long?
0 / 20
Blood Type
*
Blood Type
0 Rh+
0 Rh-
AB Rh+
AB Rh-
A Rh+
A Rh-
B Rh+
B Rh-
Height
*
Weight
*
Pregnancy History
*
Yes
No
If yes when?
0 / 20
Surgery History
*
Yes
No
If yes, please explain
0 / 200
Regular Medication
*
Yes
No
If yes, please explain
0 / 200
Allergies
*
Yes
No
If yes, please explain
0 / 20
Smoking
*
Yes
No
Hysterosalpingography
*
Yes
No
If yes, please send it as an attachment
Choose File
No file chosen
Delete uploaded file
Spermiogram
*
Yes
No
If yes, please send it as an attachment
Choose File
No file chosen
Delete uploaded file
IVF History
*
Yes
No
If yes, please explain
0 / 20
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