formisoft

Infertility / IVF Intake Form

Asks about partner information, menstrual history, and obstetric history. Built for new patient intake at fertility clinics and reproductive endocrinology practices.

Questions
17
Pages
2
Time
about 4 min

Includes

  • Consent agreement
  • File upload
  • Medication list
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Your practice

Infertility / IVF Intake Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • New patient intake at fertility clinics and reproductive endocrinology practices
  • IVF cycle planning with comprehensive reproductive history documentation
  • Male and female factor infertility evaluation and workup coordination
  • Insurance pre-authorization and treatment consent documentation for assisted reproduction

What's inside

Page 1 · Your information

  1. Full NameText · Required
  2. Phone NumberPhone
  3. Email AddressEmail
  4. Partner InformationText
  5. Menstrual HistoryLong Text

Page 2 · Additional details

  1. Lifestyle FactorsLong Text
  2. Genetic HistoryLong Text
  3. Lab Results UploadFile Upload
  4. HSG/Imaging ResultsFile Upload
  5. Semen Analysis ResultsFile Upload

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 Infertility / IVF 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 17 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 Infertility / IVF Intake Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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