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FEMALE PATIENTS NAME Medical record #: THE CENTER FOR HUMAN REPRODUCTION CLINICAL CARE RESEARCH EDUCATION 21 EAST 69TH STREET NEW YORK, NEW YORK 10021AFFIRMATION OF SEXUAL INTIMACY (To be signed by
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Sexuality intimacy and fertility refers to the information related to an individual's sexual health, relationships, and ability to conceive children.
Individuals who are seeking medical treatment for fertility issues or undergoing counseling for sexual health concerns may be required to file sexuality intimacy and fertility forms.
To fill out sexuality intimacy and fertility forms, individuals must provide accurate and detailed information about their sexual history, fertility status, and any relevant medical treatments.
The purpose of sexuality intimacy and fertility forms is to allow healthcare providers to assess and address an individual's sexual and reproductive health needs.
Information such as sexual activity, fertility treatments, contraception use, and any related medical conditions must be reported on sexuality intimacy and fertility forms.
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