Ferticlinic – Digital Consents

Treatment plan

Cycle start date

Mode: Single patient Couple (both must sign)

Required consents are predefined by the clinic and cannot be unchecked.

Primary patient

Full name

MRN / ID

Date of birth

Mobile

Partner details (for couple consents)

Partner full name

Partner ID / passport

Relationship

Facial check (liveness + match)

Before you sign, we need to re-confirm your identity by a short facial verification.

Patient signature

Full name (as signature text)

Facial verification required before enabling signature.

I confirm I have read and understood all consents above and this is my electronic signature.

Partner signature

Partner full name (as signature text)

Facial verification required before enabling signature.

I confirm I have read and understood the consents related to my participation and this is my electronic signature.