INITIAL DIAGNOSIS AND DIAGNOSIS FORM

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Initial Diagnosis and Diagnosis Form

Have you been trying to conceive for at least six months with no luck?

Yes

Do you have pain in the upper abdomen, lower abdomen or back-lumbar regions on certain days of the month?

Yes

Do you have irregular or very heavy periods?

Yes

Have you had a cesarean section or any other abdominal surgery?

Yes

Have you been diagnosed with endometriosis, fibroids, or polyps in your uterus?

Yes

Are your periods irregular?

Yes

Have you ever had a miscarriage?

Yes

Have you been diagnosed with polycystic ovary syndrome?

Yes

Have you ever consulted a doctor for a diagnosis of infertility?

Yes

Have you been diagnosed with infertility?

Yes

Have you had IVF treatment?

Yes

Your Contact Information

Name Surname:

E Mail:

Phone Number:

Age:

Other Information You Want to Submit:

UMAY IVF CENTER

As the Umay IVF Center team, we strive to maintain the highest level of satisfaction by providing the quality service that patients and their families deserve in the field of IVF and treatments, which is our area of expertise.

CONTACT

Mücahitler Mh. Ömer Ersoy Cd. No: 20/B Şehitkamil/GAZİANTEP

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