Kinderwunsch BodenseeConsultation

Pregnancy questionnaire

You have undergone fertility treatment. Due to legal regulations, we are obliged to submit anonymized reports on all treatment cycles carried out at our center to the German IVF Registry (D.I.R.). We therefore ask for your support!

Please place this questionnaire in your maternity log and answer it, with the help of the doctor who cared for you during your pregnancy if necessary.


    How many fetuses were detected on the ultrasound?



    [checkbox indergebaermutter class:form-control use_label_element exclusive "one" "two

    [checkbox ausserhalbgebaermutter class:form-control use_label_element exclusive "none" "one"]




    Result


    If inpatient hospital treatment was required, number of days treated:



    1st child

    2nd child

    1st child

    2. Kind

    2nd child

    2. Kind

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    Pregnancy Forms Download

    You can also download the form and send the completed version to us by mail or email.

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