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IVF Refund
Participation Request Form

 

If you do not have a participating center in your area, time permitting, we will make an attempt to find one for you.  Due to the volume of requests, we will not be able to get back with you.  If an IVF Center takes your case, they will be in touch with you.  We encourage you to continue your search.
 

REQUIRED:  I accept.

I am requesting IVFrefund.com to forward my information to a participating IVF center on my behalf.  In the event there is not a participating IVF center in my area, my information may be shared with other fertility centers who provide fertility treatment options.  I understand IVFrefund.com is under no obligation to complete this request.  I also understand that this form is not a secure means of transmitting personal information.  IVFrefund.com will respect my privacy by making reasonable efforts to keep information shared between medical professionals.

Name:
Phone:
Email:
City:
State:
Age of Female:
Ever had IVF treatment:
Comments:
 
 
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