Get Referral Form For Fertility Assessment

Filling out the Referral Form for Fertility Assessment is a crucial step towards obtaining necessary fertility services. This guide provides a detailed, step-by-step walkthrough to help users complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the full name and address of the person seeking assessment.
3. Next, complete the 'Partner Information' section with the full name and address of the partner.
4. Fill out the 'GP Information' with the name and address of the general practitioner (GP) referring the couple.
5. Provide the Date of Birth (DoB) and NHS Number for both the patient and their partner. Enter their home and mobile telephone numbers.
6. Enter the referral date in the specified field.
7. Complete the 'Initial Lifestyle Advice' section. The GP should include lifestyle considerations, such as smoking cessation, weight management, alcohol intake, and folic acid supplementation.
8. Indicate if there are any concerns regarding past medical or social history that may affect the welfare of an unborn child. Answer Yes or No and, if applicable, provide detailed information.
9. Choose the appropriate investigations conducted prior to referral. This may include tests for menstrual cycles, hormone levels, and semen analysis results.
10. Document any other investigations and their corresponding dates and results, if available.
11. Review and finalize the 'Referred by' section. The GP must sign, date, and print their name.
12. Once all sections are completed, save changes to the form. Options to download, print, or share the completed referral form are available.

Take the next step towards your fertility assessment by completing the Referral Form online today.