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Fertility Clinic Intake Form

Asks about partner information, duration of infertility, and pregnancy history. Built for reproductive endocrinology and infertility practices.

Questions
22
Pages
3
Time
about 6 min

Includes

  • E-signature
  • File upload
  • Medication list
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Your practice

Fertility Clinic Intake Form

Page 1 of 3 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Reproductive endocrinology and infertility practices
  • In vitro fertilization (IVF) and assisted reproduction centers
  • Fertility preservation programs for oncology patients
  • Donor egg, donor sperm, and gestational carrier coordination

What's inside

Page 1 · Your information

  1. Full NameText · Required
  2. Date of BirthDate
  3. Phone NumberPhone
  4. Email AddressEmail

Page 2 · Additional details

  1. Prior Fertility TreatmentsLong Text
  2. Prior Fertility Test ResultsLong Text
  3. Ovarian Reserve TestingLong Text
  4. Gynecologic Surgical HistoryLong Text

Page 3 · Additional details

  1. Current Medications & SupplementsMedications
  2. Psychosocial ScreeningLong Text
  3. Family Building GoalsLong Text
  4. Insurance & Fertility CoverageText

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Fertility Clinic Intake Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 22 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Fertility Clinic Intake Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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