A referral from your primary care provider is preferred but not essential.

If you are self referring copies of results of any investigations and previous treatments are helpful. Please contact Repromed on (09) 524 1232 or email us at enquiries@repromed.co.nz

Medical History Questionnaire

It is essential to gather medical information to assess your chances of having a baby. If you have decided to seek treatment at Repromed please complete the questionnaires below. You will sign this form and discuss this information with your doctor at your first appointment. Please complete this online form and bring a printed copy with you to your initial doctor consultation or send via email using the submit button at the end of this form prior to your visit.

Female Questionnaire

Male Questionnaire