We ask you to populate the below form to assist us in preparing for your initial appointment.

The form will be sent securely to an nhs.net email address.

Closer to the date of your appointment we shall contact you by telephone, following which we will send consent forms to the email address you provide in the form below.

If you have any queries or issues with the form, please contact the admin team on 0113 20 63100 - option #1

*Please only complete the below form if you have been requested to following receipt of a referral letter or if you have been directed to by a member of the Leeds Fertility team*

Registration Details

We ask both partners to please complete the below forms, which will allow us to process your referrals and send you the consents prior to your initial appointments

The referred person is the person named on the receipt of referral letter.
We would like to store your information so that we can contact you later. We will store your records in accordance with GDPR guidance and data processing legislation.
Prior to the initial appointment, we will send out online consent forms to email addresses to be completed before attending.

This next section needs to be completed by the partner

Complete if different to above
Complete if different to above
We would like to store your information so that we can contact you later. We will store your records in accordance with GDPR guidance and data processing legislation.
Prior to the initial appointment, we will send out online consent forms to email addresses to be completed before attending.