Please complete your health history as accurately as possible. This form will be the medical history used for the California Conceptions program. Please do not complete this form unless you are ready to move forward with treatment.
If you are already a patient at California IVF Fertility Center, please check with our staff before you complete this history form. Accurate information is important to help us provide you with the best possible care. Be sure to use your legal name as it appears on your driver’s license or other form of government issue ID. Please only submit one history form.
Please read each of the questions carefully and the icon labeled “i” can provide additional information. The form takes approximately 20-30 min to complete unless your history is very complex.