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Make an appointment

IFEM Endo is specialized in the treatment of endometriosis. We therefore only see patients who already have a confirmed diagnosis of endometriosis.

Unfortunately, presently our team is unable to carry out screening consultations for women or adolescents who have symptoms compatible with endometriosis, but who do not yet have a clinical examination or scan to confirm the diagnosis.

Make an appointment
new patient

You have a confirmed diagnosis of endometriosis and would like to make an appointment for a consultation at our center.

Make an appointment
follow-up patient

You have already consulted a doctor at IFEM Endo and would like to make a new appointment for a follow-up.

Last updated on May 19, 2021 @ 11:17

New patient appointment

If you have never been to our center before, please fill out the health questionnaire below:

YOUR CONTACT INFORMATION



ADMINISTRATON DETAILS

Your medical insurance* : (please provide a current health insurance certificate (Health cover provider, CMU, ACS or AME

Do you wish to be referred to a specific doctor?


MEDICAL QUESTIONNAIRE

Please also complete this medical information which will help us to understand your situation and provide the most appropriate care:
Do you have children ?*
If yes, how did you conceive?
Do you currently wish to become pregnant ?*
For how long have you been trying?

Have you ever had surgery for endometriosis? *
Please attach surgery reports (Optional):

Are you taking hormonal treatment (medical or contraceptive) ?*

Do you have pain during your periods?*
Do you have pain outside of your periods?*
Do you have pain during sexual intercourse?*
Do you have digestive problems during your periods (pain when having a bowel movement, diarrhea, bloating...)? *
If you have any other painful symptoms during your periods, please explain below:


Please upload your mandatory MRI report dated preferably within the last year: *
You can also upload any doctor's letter(s):

*Required fields.

Make an appointment: patient follow-up

You have already consulted a doctor at IFEM Endo and would like to make another appointment for your follow-up. You can contact us quickly using the form below.


Your doctor? *
Please explain your problem :

*Required fields.