IVF Application Form
  1. On this page you can apply to start IVF procedure with Human First. Specifies to know to be interested in additional information on an IVF attempt in Turkey. We will then contact you by telephone or email and further information about the treatment options. Would you be so kind as to fill out the form below as completely as possible ? We also request you to scan your medical records regarding any previous IVF or ICSI treatments and send it to us via info@humanfirst.nl. Your medical information to the IVF team will be presented in Turkey and you will receive within 7 business days notice from us regarding your suitability for IVF / ICSI treatment . Your data will be confidentially and discreetly. You also can additional questions, please call 010-42 33 440
  2. Personal information Female
  3. Name(*)
  4. Insertion
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  5. Surname(*)
  6. Insurance Company(*)
  7. Weight (kg)(*)
  8. Length (kg)(*)
  9. Birthday(*)
  10. Birthplace / Country(*)
  11. Smoking habbit
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  12. How many times did you get pregnant?
  13. How many times did you give birth?
  14. Birth year of your child(ren)?
  15. Intercourse without contraception since(*)
  16. Do you have a regular menstrual cycle?(*)
  17. Did you have already fertility treatments?(*)
  18. If yes, please give the treatment details below.
  19. IUI
  20. Please indicate Name of the IUI Clinic(s)
  21. IVF
  22. Please indicate Name of the IVF Clinic(s)
  23. ICSI
  24. Please indicate Name of the ICSI Clinic(s)
  25. Is there in your determined a cause for the fertility problem ? If so, can you explain this?
  26. Personal information male
  27. Name(*)
  28. Insertion
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  29. Surname(*)
  30. Insurance Company(*)
  31. Weight (kg)(*)
  32. Length (kg)(*)
  33. Birthday(*)
  34. Birthplace / Country(*)
  35. Smoking habbit
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  36. How many children do you have?
  37. Did you have sperm analyse?(*)
  38. If yes, please indicate Name of the Clinic(s) that you had sperm analyse
  39. Is there a male factor for the infertility? If yes, please explain
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  40. How did you experience your earlier fertility treatments?(*)
  41. Contact Information
  42. Phone Number(*)
  43. Mobile Number
  44. Email(*)
  45. Street Name(*)
  46. House Number(*)
  47. Postcode(*)
  48. City / Country(*)
  49. How did you hear about us?(*)
  50. What is the main reason for your interest in Human First?