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{"id":1606,"date":"2025-10-15T09:45:19","date_gmt":"2025-10-15T07:45:19","guid":{"rendered":"https:\/\/www.endlichnachwuchs.de\/formulare\/schwangerschaftsfragebogen\/"},"modified":"2026-02-27T11:08:45","modified_gmt":"2026-02-27T10:08:45","slug":"pregnancy-questionnaire","status":"publish","type":"page","link":"https:\/\/www.endlichnachwuchs.de\/en\/forms\/pregnancy-questionnaire\/","title":{"rendered":"Pregnancy Questionnaire"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10&#8243;]\r\n              <div class=\"modul-headline text-center mb-4\">\r\n                <div class=\"headlinesmall\"><img decoding=\"async\" src=\"\/wp-content\/themes\/kinderwunsch\/assets\/images\/layout\/hand.png\" alt=\"Kinderwunsch Bodensee\">Consultation<\/div>\r\n                <h2 class=\"text-center headlinestyle\">Pregnancy questionnaire<\/h2>\r\n              <\/div>\r\n            [vc_column_text css=&#8221;&#8221;]<\/p>\n<p style=\"text-align: center;\">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!<\/p>\n<p style=\"text-align: center;\">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.<\/p>\n<p>[\/vc_column_text]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1623-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1623\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/1606#wpcf7-f1623-o1\" method=\"post\" class=\"wpcf7-form init wpcf7-acceptance-as-validation\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1623\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1623-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"\">\n\t<div class=\"row\">\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"vorname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient first name*\" value=\"\" type=\"text\" name=\"vorname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nachname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient last name*\" value=\"\" type=\"text\" name=\"nachname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"emailadresse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"E-Mail*\" value=\"\" type=\"email\" name=\"emailadresse\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"telefon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Phone\" value=\"\" type=\"text\" name=\"telefon\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"konzeptionsdatum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Date of conception (PU\/IUI)\" value=\"\" type=\"text\" name=\"konzeptionsdatum\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"geburtsdatum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Date of birth\" value=\"\" type=\"text\" name=\"geburtsdatum\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><label>When was the pregnancy confirmed?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"feststellungsdatum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Date of confirmation\" value=\"\" type=\"text\" name=\"feststellungsdatum\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12 mb-2\">\n\t\t\t<p><strong>How many fetuses were detected on the ultrasound?<\/strong>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-4\">\n\t\t\t<p><label>Date of ultrasound<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"datumultraschall\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Date of ultrasound\" value=\"\" type=\"text\" name=\"datumultraschall\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-4\">\n\t\t\t<p><label>In the uterus<\/label><br \/>\n[checkbox indergebaermutter class:form-control use_label_element exclusive \"one\" \"two\n    <\/div>\n    <div class=\"col-md-4\">\n      <label>Outside the uterus<\/label>\n      [checkbox ausserhalbgebaermutter class:form-control use_label_element exclusive \"none\" \"one\"]\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><label>If there was an ectopic pregnancy, how was it treated?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"eileiterschwangerschaft\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Type of treatment\" value=\"\" type=\"text\" name=\"eileiterschwangerschaft\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><label>Pregnancy course<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"schwangerschaftsverlauf\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox form-control\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"schwangerschaftsverlauf\" value=\"normal\" \/><span class=\"wpcf7-list-item-label\">normal<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"schwangerschaftsverlauf\" value=\"Spontaneous miscarriage\" \/><span class=\"wpcf7-list-item-label\">Spontaneous miscarriage<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"schwangerschaftsverlauf\" value=\"Induced abortion\" \/><span class=\"wpcf7-list-item-label\">Induced abortion<\/span><\/label><\/span><\/span><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"datumfehlgeburtabort\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control mb-3 d-none schwangerschaftsverlauf\" aria-invalid=\"false\" placeholder=\"Date\" value=\"\" type=\"text\" name=\"datumfehlgeburtabort\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"fehlgeburtabortursache\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control schwangerschaftsverlauf d-none\" aria-invalid=\"false\" placeholder=\"If the cause of the miscarriage is known, please describe it here.\" value=\"\" type=\"text\" name=\"fehlgeburtabortursache\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><label>Was a prenatal examination of the child performed (e.g., amniocentesis or villus sampling)?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"vorgeburtlicheuntersuchung\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox form-control\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"vorgeburtlicheuntersuchung\" value=\"no\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"vorgeburtlicheuntersuchung\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/label><\/span><\/span><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"datumvorgeburtlicheuntersuchung\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control mb-3 d-none formvorgeburtlicheuntersuchung\" aria-invalid=\"false\" placeholder=\"Date\" value=\"\" type=\"text\" name=\"datumvorgeburtlicheuntersuchung\" \/><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"formvorgeburtlicheuntersuchung d-none\">\n\t\t\t\t<p><span style=\"font-weight:600;\">Result<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"ergebnisvorgeburtlicheuntersuchung\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox form-control\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"ergebnisvorgeburtlicheuntersuchung\" value=\"Unremarkable\" \/><span class=\"wpcf7-list-item-label\">Unremarkable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"ergebnisvorgeburtlicheuntersuchung\" value=\"Remarkable\" \/><span class=\"wpcf7-list-item-label\">Remarkable<\/span><\/label><\/span><\/span><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"vorgeburtauffaellig\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control d-none formvorgeburtlicheuntersuchung2\" aria-invalid=\"false\" placeholder=\"Describe\" value=\"\" type=\"text\" name=\"vorgeburtauffaellig\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><label>How did the pregnancy progress after the 20th week of pregnancy?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"schwangerschaftsverlauf20\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox form-control\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"schwangerschaftsverlauf20\" value=\"Unremarkable\" \/><span class=\"wpcf7-list-item-label\">Unremarkable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"schwangerschaftsverlauf20\" value=\"Remarkable\" \/><span class=\"wpcf7-list-item-label\">Remarkable<\/span><\/label><\/span><\/span><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"schwangerschaftsverlaufbeschreibung\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control schwangerschaftsverlaufadd d-none\" aria-invalid=\"false\" placeholder=\"Describe\" value=\"\" type=\"text\" name=\"schwangerschaftsverlaufbeschreibung\" \/><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"schwangerschaftsverlaufadd d-none\">\n\t\t\t\t<p>If inpatient hospital treatment was required, number of days treated:<span class=\"wpcf7-form-control-wrap\" data-name=\"krankenhausbehandlung\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Number of days treated\" value=\"\" type=\"text\" name=\"krankenhausbehandlung\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><label>Date of Birth<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"geburstdatum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Date of birth\" value=\"\" type=\"text\" name=\"geburstdatum\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><label>How did the birth proceed?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"geburtsverlauf\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox form-control\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"geburtsverlauf\" value=\"Normal\" \/><span class=\"wpcf7-list-item-label\">Normal<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"geburtsverlauf\" value=\"Cesarean section\" \/><span class=\"wpcf7-list-item-label\">Cesarean section<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"geburtsverlauf\" value=\"Forceps delivery\" \/><span class=\"wpcf7-list-item-label\">Forceps delivery<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"geburtsverlauf\" value=\"Vacuum extraction\" \/><span class=\"wpcf7-list-item-label\">Vacuum extraction<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"geburtsverlauf\" value=\"Breech delivery\" \/><span class=\"wpcf7-list-item-label\">Breech delivery<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12 mb-2\">\n\t\t\t<p><label>Please indicate the weight and height of the child\/children:<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p>1st child<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"k1gewicht\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control mt-2\" aria-invalid=\"false\" placeholder=\"Weight in grams\" value=\"\" type=\"text\" name=\"k1gewicht\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"k1groesse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Height in cm\" value=\"\" type=\"text\" name=\"k1groesse\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p>2nd child<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"k2gewicht\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control mt-2\" aria-invalid=\"false\" placeholder=\"Weight in grams\" value=\"\" type=\"text\" name=\"k2gewicht\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"k2groesse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Height in cm\" value=\"\" type=\"text\" name=\"k2groesse\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12 mb-2\">\n\t\t\t<p><label>What is the gender of your child\/children?<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p>1st child<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"k1geschlecht\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox form-control\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"k1geschlecht\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"k1geschlecht\" value=\"Male\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p>2. Kind<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"k2geschlecht\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox form-control\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"k2geschlecht\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"k2geschlecht\" value=\"Male\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12 mb-2\">\n\t\t\t<p><label>Is your child\/are your children healthy, or do they have any illnesses?<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p>2nd child<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"k1gesund\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox form-control\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"k1gesund\" value=\"healthy\" \/><span class=\"wpcf7-list-item-label\">healthy<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"k1gesund\" value=\"not healthy\" \/><span class=\"wpcf7-list-item-label\">not healthy<\/span><\/label><\/span><\/span><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"k1krankheit\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"If not healthy, what illnesses do they have?\" value=\"\" type=\"text\" name=\"k1krankheit\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p>2. Kind<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"k2gesund\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox form-control\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"k2gesund\" value=\"healthy\" \/><span class=\"wpcf7-list-item-label\">healthy<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"k2gesund\" value=\"not healthy\" \/><span class=\"wpcf7-list-item-label\">not healthy<\/span><\/label><\/span><\/span><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"k2krankheit\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"If not healthy, what illnesses do they have?\" value=\"\" type=\"text\" name=\"k2krankheit\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12 mb-2\">\n\t\t\t<p><label>Which doctor could we contact if we need further information?<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 mb-2\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"arztname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Doctor&#039;s name\" value=\"\" type=\"text\" name=\"arztname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 mb-2\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"arztanschrift\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Doctor&#039;s address\" value=\"\" type=\"text\" name=\"arztanschrift\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"arztplzort\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Doctor&#039;s postal code\/city\" value=\"\" type=\"text\" name=\"arztplzort\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"zustimmungagb\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"zustimmungagb\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I have read and understood the <a href=\"\/en\/privacy-policy\/\" style=\"color:var(--default);text-decoration:none;\">privacy policy<\/a>. I agree that my contact details and any queries I may have will be stored permanently.  Please note: You can revoke your consent at any time by sending an email to info@endlichnachwuchs.de.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner btn btn-primary btn-outline btn-rounded btn-inverse\" type=\"submit\" value=\"Send Questionnaire\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row&#8221; el_class=&#8221;bg-grey&#8221; css=&#8221;.vc_custom_1761294692982{margin-bottom: 0px !important;padding-top: 80px !important;}&#8221;][vc_column css=&#8221;.vc_custom_1761026461442{margin-bottom: 20px !important;}&#8221;]\r\n              <div class=\"modul-headline text-start mb-4\">\r\n                <div class=\"headlinesmall\"><img decoding=\"async\" src=\"\/wp-content\/themes\/kinderwunsch\/assets\/images\/layout\/hand.png\" alt=\"Kinderwunsch Bodensee\">Send by mail or e-mail<\/div>\r\n                <h3 class=\"text-start headlinestyle\">Pregnancy Forms Download<\/h3>\r\n              <\/div>\r\n            [vc_column_text css=&#8221;&#8221;]You can also download the form and send the completed version to us by mail or email.[\/vc_column_text][\/vc_column][vc_column css=&#8221;.vc_custom_1765383397591{margin-bottom: 32px !important;}&#8221; offset=&#8221;vc_col-lg-6&#8243;][vc_row_inner equal_height=&#8221;yes&#8221; el_class=&#8221;innerrowspecial&#8221;][vc_column_inner width=&#8221;1\/2&#8243;]\r\n            <div class=\"featured-boxes featured-boxes-flat\">\r\n                <div class=\"featured-box featured-box-primary featured-box-effect-2\">\r\n                    <div class=\"box-content box-content-border-bottom\">\r\n                        <i class=\"icon-featured fa fa-solid fa-location-dot\"><\/i>\r\n                        <div> <p style=\"text-align: center;\">KINDERWUNSCH BODENSEE<br \/>\nPraxis Dr. med. Andreas Heine<\/p>\n<p style=\"text-align: center;\">Maggistra\u00dfe 5<br \/>\nHegau Tower<br \/>\n78224 Singen<\/p>\n<\/div>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            [\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243;]\r\n            <div class=\"featured-boxes featured-boxes-flat\">\r\n                <div class=\"featured-box featured-box-primary featured-box-effect-2\">\r\n                    <div class=\"box-content box-content-border-bottom\">\r\n                        <i class=\"icon-featured fa fa-solid fa-envelope\"><\/i>\r\n                        <div> <p style=\"text-align: center;\">info@endlichnachwuchs.de<\/p>\n<\/div>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            [vc_empty_space]\r\n            <div class=\"module-button text-center\">\r\n                <a href=\"https:\/\/www.endlichnachwuchs.de\/wp-content\/uploads\/Schwangerschafts-Fragebogen.pdf\" target=\"_blank\"  class=\"btn btn-outline btn-rounded btn-primary  mb-2\">Download<\/a>\r\n            <\/div>\r\n            [\/vc_column_inner][\/vc_row_inner][\/vc_column][vc_column css=&#8221;.vc_custom_1765383387872{margin-bottom: 48px !important;}&#8221; offset=&#8221;vc_col-lg-6&#8243;]\n                <div class=\"cascading-images-wrapper pb-0\">\n                    <div class=\"cascading-images position-relative\">\n                        <div class=\"position-absolute top-0 right-0 bottom-0 left-0\" data-plugin-float-element=\"\" data-plugin-options=\"{'startPos': 'top', 'speed': 0.1, 'transition': true, 'horizontal': true, 'transitionDuration': 1000, 'isInsideSVG': true}\" style=\"top: 0px; transition: transform 1000ms ease-out; transform: translate3d(7.18908%, 0px, 0px);\">\n                            <div class=\"border-radius-kiwu cascading-images-colored-bar bg-primary position-absolute top-0 right-0 bottom-0 left-0 appear-animation animated fadeIn appear-animation-visible\" data-appear-animation=\"fadeIn\" data-appear-animation-duration=\"600ms\" style=\"animation-duration: 600ms; animation-delay: 100ms;\"><\/div>\n                        <\/div>\n                        <div class=\"position-relative\" style=\"top: 35px; left: 35px;\">\n                            <img decoding=\"async\" src=\"https:\/\/www.endlichnachwuchs.de\/wp-content\/uploads\/36-SS-Bogren-Seite-AdobeStock_1273092652-min.jpeg\" class=\"border-radius-kiwu appear-animation box-shadow-3 animated fadeIn appear-animation-visible\" width=\"500\" alt=\"\" data-appear-animation=\"fadeIn\" data-appear-animation-delay=\"500\" data-appear-animation-duration=\"600ms\" style=\"animation-duration: 600ms; animation-delay: 500ms;\">\n                        <\/div>\n                    <\/div>\n                <\/div>\n[\/vc_column][\/vc_row][vc_row][vc_column][vc_empty_space][\/vc_column][\/vc_row][vc_row][vc_column]<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column css=&#8221;.vc_custom_1760610705796{margin-bottom: 0px !important;}&#8221;]\n            <div class=\"container modul--testimonial \">\n                <div class=\"row\">\n                    <div class=\"col-lg-5 text-center order-2 order-lg-1\">\n                        <img decoding=\"async\" src=\"https:\/\/www.endlichnachwuchs.de\/wp-content\/uploads\/Rueckmeldungen_A7_0497-min.jpg\" class=\"img-fluid border-radius-kiwu\" alt=\"Kinderwunsch\" \/>\n                    <\/div>\n                    <div class=\"col-lg-7 align-self-center pb-lg-5 order-1 order-lg-2 ps-0 \">\n                        <div class=\"porto-carousel owl-carousel has-ccols ccols-1 carousel-center-active-item-full rounded-nav\" data-plugin-options=\"{&quot;themeConfig&quot;:true,&quot;stagePadding&quot;:0,&quot;margin&quot;:0,&quot;autoplay&quot;:true,&quot;mouseDrag&quot;:true,&quot;touchDrag&quot;:true,&quot;autoplayTimeout&quot;:8000,&quot;autoplayHoverPause&quot;:false,&quot;items&quot;:1,&quot;xl&quot;:1,&quot;lg&quot;:1,&quot;md&quot;:1,&quot;sm&quot;:1,&quot;xs&quot;:1,&quot;nav&quot;:&quot;yes&quot;,&quot;dots&quot;:false,&quot;animateIn&quot;:&quot;&quot;,&quot;animateOut&quot;:&quot;&quot;,&quot;loop&quot;:&quot;yes&quot;,&quot;center&quot;:&quot;yes&quot;,&quot;video&quot;:false,&quot;lazyLoad&quot;:false,&quot;fullscreen&quot;:false}\">\n                            <div class=\"px-4 px-md-5 testimonial testimonial-style-2 testimonial-with-quotes testimonial-remove-right-quote testimonial-quotes-dark custom-testimonial-quote-position-1 mb-0\">\n                                <blockquote>\n                                    <p class=\"alternative-font-4 font-weight-medium text-start text-4 px-0 px-md-5 mb-0 mt-4 mt-md-0\">I would like to thank you from the bottom of my heart for your dedication and professionalism. After such a long wait, I can finally hold my baby in my arms thanks to you. She is now 3 months old. You are the best. Success on the first try. Highly recommended. Very good and dedicated doctors. Thank you, see you soon.<\/p>\n                                <\/blockquote>\n                                <div class=\"testimonial-author text-start ps-5 ms-2 opacity-5\">\n                                    <strong class=\"text-4-5 negative-ls-1 mb-1\">A.K. <\/strong>\n                                    <p class=\"text-color-default text-start mb-0\">August 2025<\/p>\n                                <\/div>\n                            <\/div>\n               \n                            <div class=\"px-4 px-md-5 testimonial testimonial-style-2 testimonial-with-quotes testimonial-remove-right-quote testimonial-quotes-dark custom-testimonial-quote-position-1 mb-0\">\n                                <blockquote>\n                                    <p class=\"alternative-font-4 font-weight-medium text-start text-4 px-0 px-md-5 mb-0 mt-4 mt-md-0\">We can recommend the clinic 100% and say, get help promptly and don't wait. We had years of trying unsuccessfully to have children. Then we went to the clinic. It was a real relief. Our starting position was as bad as it could be. And yet it worked on the second attempt. Without the Bodensee Fertility Clinic, we would never have become parents to a wonderful boy. We found the support and care provided by the entire team to be very warm and empathetic. We also found the balance between justified hope and realistic medical assessment to be very good. Costs were communicated transparently and not artificially inflated. We always had a choice. A top clinic!\n<\/p>\n                                <\/blockquote>\n                                <div class=\"testimonial-author text-start ps-5 ms-2 opacity-5\">\n                                    <strong class=\"text-4-5 negative-ls-1 mb-1\">M.H. <\/strong>\n                                    <p class=\"text-color-default text-start mb-0\">January 2025<\/p>\n                                <\/div>\n                            <\/div>\n               \n                            <div class=\"px-4 px-md-5 testimonial testimonial-style-2 testimonial-with-quotes testimonial-remove-right-quote testimonial-quotes-dark custom-testimonial-quote-position-1 mb-0\">\n                                <blockquote>\n                                    <p class=\"alternative-font-4 font-weight-medium text-start text-4 px-0 px-md-5 mb-0 mt-4 mt-md-0\">I would like to express my heartfelt thanks to you today! Thanks to your support and the empathetic treatment provided by Dr. Simon and Dr. Heine, I am now delighted to report that I am 19 weeks pregnant.\nWe are overjoyed and sometimes still cannot believe our luck. After all the hopes, doubts, and the long journey, this dream has finally come true\u2014and that would not have been possible without your competent, loving, and patient care.\nI would especially like to express my sincere gratitude to Dr. Simon. Your empathetic manner, patience, and commitment have given us courage time and again. I always felt that I was in good hands and understood.\nI would very much like to come by in person to thank you all once again. Please let me know if that would be possible.\nThank you so much for walking this path with us and accompanying us so wonderfully. You give hope to so many couples \u2014 and now you have given us a little miracle.\nWarmest and grateful regards<\/p>\n                                <\/blockquote>\n                                <div class=\"testimonial-author text-start ps-5 ms-2 opacity-5\">\n                                    <strong class=\"text-4-5 negative-ls-1 mb-1\">S.O. <\/strong>\n                                    <p class=\"text-color-default text-start mb-0\">July 2025<\/p>\n                                <\/div>\n                            <\/div>\n               \n                            <div class=\"px-4 px-md-5 testimonial testimonial-style-2 testimonial-with-quotes testimonial-remove-right-quote testimonial-quotes-dark custom-testimonial-quote-position-1 mb-0\">\n                                <blockquote>\n                                    <p class=\"alternative-font-4 font-weight-medium text-start text-4 px-0 px-md-5 mb-0 mt-4 mt-md-0\">Top fertility clinic! We are grateful for everything and would recommend it to anyone without hesitation.\nThank you for everything \u2661<\/p>\n                                <\/blockquote>\n                                <div class=\"testimonial-author text-start ps-5 ms-2 opacity-5\">\n                                    <strong class=\"text-4-5 negative-ls-1 mb-1\">Z.F. <\/strong>\n                                    <p class=\"text-color-default text-start mb-0\">August 2025<\/p>\n                                <\/div>\n                            <\/div>\n               \n                            <div class=\"px-4 px-md-5 testimonial testimonial-style-2 testimonial-with-quotes testimonial-remove-right-quote testimonial-quotes-dark custom-testimonial-quote-position-1 mb-0\">\n                                <blockquote>\n                                    <p class=\"alternative-font-4 font-weight-medium text-start text-4 px-0 px-md-5 mb-0 mt-4 mt-md-0\">The entire team around Dr. Heine is simply a blessing. From the receptionists to the doctors and colleagues to the laboratory, everything was just great. Everyone was warm and competent. We felt comfortable from the very first consultation. We had been to another practice before and eventually became just a number there and were no longer treated properly. With Dr. Heine, we got pregnant right away in the first ICSI cycle and continued to receive excellent treatment throughout the pregnancy. Now we are holding our fourth child, whom we wanted so much, healthy in our arms. Thank you so much for everything!<\/p>\n                                <\/blockquote>\n                                <div class=\"testimonial-author text-start ps-5 ms-2 opacity-5\">\n                                    <strong class=\"text-4-5 negative-ls-1 mb-1\">A.S. <\/strong>\n                                    <p class=\"text-color-default text-start mb-0\">January 2026<\/p>\n                                <\/div>\n                            <\/div>\n               <\/div><\/div><\/div><\/div>[\/vc_column][\/vc_row]<\/p>\n<\/div><style type=\"text\/css\" data-type=\"rcb-_wpb_shortcodes_custom_css-1485\">.vc_custom_1760610705796{margin-bottom: 0px !important;}<\/style>[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"Consultation 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! 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