Infertility Acupuncture Fertility Pregnancy Treatment The Fertile Soul

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Patient Consult Forms

Please fill out the proper forms prior to your appointment to help us get to know you and your medical history. These will only take a few moments of your time. Please return copies via:

Email: jesse@thefertilesoul.com       (Retreat Information)

          theresa@thefertilesoul.com    (Phone Consult Information)

Fax: (203) 774-1119

TFS Patient Form (Female)
TFS Patient Form (Male)
Physical Questionnaire (Female)
Physical Questionnaire (Male)
Nutrition Intake Form
Lifestyle Questionnaire

*If using a Mac computer - "Open PDF in Preview" before filling out the form OR Save the PDF to your computer prior to filling out (information will not save properly if filled out directly from web)

The forms on this page require you to have Adobe Acrobat Reader installed on your system. Click the icon to download...