Fertility Patient Forms

New Patient Forms / Clinic Information

Welcome to urban sense wellness clinic.


This page contains important information about your forthcoming fertility appointment and requires you and your partner to complete your own separate online New Patient Health History Form if you are both of you are attending this appointment. (See link below)


What Happens at Your Initial Consultation?

Prior to your consultation, your Practitioner will review your completed New Patient Health History Forms.


This information will allow your Practitioner to undertake a detailed and comprehensive discussion during your consultation about your current health history and establish your key health goals.


Initial Consultation Duration

Please allow between 70 - 90 minutes for your initial consultation.

Patient Fees

Information on our fees are located on our Schedule of Fees page.


New Patient Health History Form - Online Electronic Form

As part of our integrated approach to your health, we request that you complete the Online Patient Health History Form. A link is attached below. Note: Other appointment types may require a different form.

For couples attending an initial consultation, we ask that you complete your own individual Male / Female Health History Form respectively.

Female Health History Form - Fertility

Click here to complete your Female Health History Form

Male Health History Form - Fertility 

Click here to complete your Male Health History Form

You will notice that the information we ask you to supply is both extensive and thorough in its level of detail. The more information you’re able to supply to us, will assist in helping your Practitioner understand your specific health issues as comprehensively as possible. It will also contribute to the development of any future treatment plan.



To complete this information properly takes some patients at least 20 minutes. Please allow yourself enough time prior to returning your forms to complete this task.


How to Complete the Form

The Patient History Form is completed online electronically.

When Does This Form Need to be Completed?

Your completed Patient Form needs to be completed online, at least 72 hours prior to your initial appointment.


Please Note. If you are unable to complete your online New Patient Health History Form, please let our reception staff know as soon as possible


Arriving late to your appointment means that there will be less time available to see your Practitioner and can lead to undue stress on the day.


Pathology / Blood Tests

In addition to the above, we recommend that you complete the following blood tests if possible before your initial appointment. If you have completed any of these tests with your GP or another practitioner within the last six months please ask for a copy of these tests to bring along with you to your consultation.  We are unable to request these on your behalf.


Full Blood Count

Full Biochemistry (Including Uric Acid and Liver Function)

Lipid Studies

FBE and Iron Studies

Serum Copper and Plasma Zinc

RBC Folate and Serum B12

Fasting Homocysteine

Thyroid Function Test: TSH, FT4, FT3

Vitamin D

Fasting Insulin and HbA1c


These tests are not compulsory to attend your initial appointment, but help in providing your Practitioner with an accurate picture of your current nutritional and health issues. This is an evidence based natural medicine clinic and results of Pathology Testing if required, can take sometimes 2-6 weeks before your results are ready.

Please email your pathology results to reception@urbansense.com.au


Current Medications and Supplements

Please bring along to your consultation, all of your current prescription medications and supplements.


Initial Consultation and Additional Fees

In addition to your Initial Appointment Consultation Fee, further charges may apply for Nutritional and Herbal Supplements, Diagnostic Assessments, and Pathology Testing. Your Practitioner will discuss this with you at your consultation, should these be required.


Payment for your consultation is due on the day of your appointment.

Young Children and Infants

To make the best use of your consultation and to allow your Practitioner to focus on you and your health concerns, we recommend if possible, that infants and young children be left at home with a relative as they can easily be distracted and become restless during this extended initial appointment.


Cancellation Policy

If you are unable to attend your appointment for any reason, please call the clinic 48 hours in advance to enable cancellation and re-scheduling of your appointment. If we do not receive sufficient notice, a cancellation fee will be charged. This fee will need to paid before you can re-book another consultation.


Our Location

Urban sense wellness clinic is located at 275 St Georges Road, Northcote which is approximately 8km’s north of the Melbourne CBD.


Patient Parking

There is free 2 hour on street parking available out the front of the clinic or in nearby Emmaline Street.


Public Transport

The Route 11 West Preston tram runs along St Georges Road if you are coming by public transport.  The Tram stop No is 32 or 34.


Alternatively, the Mernda train line stops at Croxton Railway Station, a few streets away from the clinic. The clinic is only a short 7 minute walk from the railway station.


We look forward to seeing you and becoming your partner in wellness.

urban sense wellness clinic