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*