Pre-test questionnaire

A few questions before your semen analysis. Your answers help our clinical team interpret your results accurately. All information is confidential.

1

About you

Basic details for your record.

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2

Lifestyle

These factors can affect sperm health, so please answer as accurately as you can.

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3

Fertility history

Helps us understand where you are in your journey.

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4

Medical history

Please include anything relevant, even if it seems minor.

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Review & submit

Please check your answers before sending.

I confirm the information provided is accurate to the best of my knowledge, and I consent to Marylebone Diagnostic Centre using it for clinical assessment in line with the Privacy Policy

Great! We’ve received your information.