Have you had any tests done before? If yes:
Any previous operations?
Any chronic diseases? If yes, please provide details.
At how many weeks did you miscarriage?First miscarriageSecond miscarriageThird miscarriage
Any diagnosis for the etiology?
(Do you know the cause of the miscarriage?)
Regular intercourse (/week)?
Is this your first marriage?YesNo
If no, have either of you had a pregnancy before?YesNo
Note: Our fertility department will be in contact with you soon to arrange your appointment.
Saturday - Thursday
9:00AM - 1:00PM
5:00PM - 9:00PM
Fridays and Public Holidays – Closed
We do not run an emergency service
Date of your last menstrual period:
Your Last Cycle At:
Your baby will come on approximately: