LIFE without

fibroids

CONTACT US

Get in contact with us! Here are some helpful quick downloads:

Click Here to download UFE History Form (PDF Document) 

Click Here to download UFE History Form (Word Document)

Patient Assessment

All questions contained in this questionnaire are strictly confidential and will become part of your medical record.

"*" indica campos obrigatórios

All questions contained in this questionnaire are strictly confidential and will become part of your medical record.

Name*
Please select the location closest to you*
Do you suffer from any of the following?*