Zita West

Black, Black British, Caribbean or African

No embryos suitable for use due to abnormal genetic test result

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Embed any online content: Google Maps, Calendly, GitHub Gist, online PDFs, Tweets, Figma files and more.

Embed audio from SoundCloud, Spotify, .MP3s and more. Insert this embed block and paste the audio URL or embed link.

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Use this to collect files, like a portfolio or resume.

Big heading suitable for a title of main sections in your form.

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Send custom data from your form link to your form submissions via URL query string parameters. <a href='{{link}}' target='_blank'>Learn more</a>.

Upload an image, add an image URL, or choose from Unsplash. Use images to visualize products or to personalize your form with your visual style.

Use this to allows respondents to pick a date in this format: Month Day, Year.

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Use this if you want a number as a response. Add a minimum and/or maximum number limit.

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Use this to add a question title and input field at the same time.

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Detect the respondent’s country automatically based on their IP address. The country will appear in the submission data without storing or tracking any personal information.

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Use this to display any type of text. You can format it as you want and customize it to your needs.

Use this for long form answers without character limits.

Add a ‘Thank you’ page to your form. This is the page your respondents will see after submitting the form.

Add a title to a question in your form. For example: ‘Ready to join our team’ as a part of an application form.

Use this to effortlessly collect wallet addresses with Wallet Connect, providing a seamless and secure connection with the most popular crypto wallets.

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Short answer

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Multiple choice

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Text

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Title

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Use this to insert a question to collect correctly formatted links or websites.

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Zita West

How did you choose the clinic?

What year did you have treatment at this clinic?

What was your age when you had treatment?

What is your ethnicity?

What factor(s) was identified as the reason for infertility?

What treatment did you have in this clinic?

What was the outcome of your treatment?

How effectively did the clinic explain the procedures and ensure that you understood what was happening throughout your treatment?

How easy was it to schedule appointments and communicate with the clinic?

How would you rate the clinical team's empathy, understanding, and support throughout your treatment journey?

How would you rate the quality of the facilities at the clinic?*

To what extent did you feel your privacy, dignity, and overall treatment experience were respected at the clinic?

How closely did the final cost of treatment align with your initial expectations? (1 star for far below expectations, 5 stars for perfectly aligned)

How likely are you to recommend this clinic to friends or family members?

Please leave a review about your experience