Fertility Intake Forms

Most clinics start with a new patient intake and a reproductive history for each partner. Then come forms for specific paths: IUI and IVF consents, egg freezing and other preservation, and applications for donors and gestational carriers.

It asks how long the patient has been trying to conceive, about menstrual cycles, past pregnancies and outcomes, earlier tests and treatments, medicines, surgeries and family history. A partner usually fills in a separate history.

Each partner has different history to cover. The female form focuses on cycles, pregnancies and gynecologic history. The male form covers past fathered pregnancies, urologic history, medicines and lifestyle factors that can affect sperm.

FertiQoL is an international questionnaire that measures how fertility problems affect quality of life, including emotions, relationships, social life and work. An optional section covers the experience of treatment. It was developed with ESHRE and ASRM.

AI Doctor, a real-time AI healthcare assistant avatar, asks the intake questions as a conversation, in the patient's own language. It collects the answers for the team to review, so the first consultation starts with both partners' histories in place.

Start with the fertility clinic new patient intake and the male and female history questionnaires, since nearly every patient needs them. Add consents for the treatments you offer, then preservation and donor forms as those services grow.

No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.

Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.