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First Name *
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Last Name *
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Email Address *
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How did you hear about us?

What’s the best description of your family group?

What appointment format do you prefer? *

How can we help you? (check all that apply)

Female / Male fertility testing

LGBTQ+ Family Building

Intrauterine Insemination (partner sperm)

Intrauterine Insemination (donor sperm)

IVF

Ontario Fertility Program (Provincially Funded IVF)

Egg Freezing (elective or non-medical reasons)

Fertility Preservation (oncology & other medical reasons)

Require Donor Eggs

Surrogacy

PGT Testing

Transfer from another IVF Centre: (list name of centre)

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Is there anything else you would like us to know? *

The following information is optional but will help us to get you set up a bit quicker

Your referring physician
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Provincial health card # (if applicable)
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Address details

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Inclusion of all gender and sexually diverse people is an important value of ReproMed Fertility. We are continuously striving to create an environment of compassionate belonging where all of the LGBTQ2SIA+ community are supported, valued and respected.

ReproMed Fertility is situated on the treaty lands and traditional territory of the Mississaugas of the Credit and homeland of Anishinaabe, Haudenosaunee, and Wendat peoples.

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