Request a laboratory referral

We are here for you.

Would you like to have your hormone levels or other parameters determined by blood test and need a referral? Simply fill out the form below and we will send it to you immediately by email.

The referral is valid for 1 month from the date of issue and can be used for any laboratory. Some parameters are not taken over by the health insurance. This concerns the antibody determination rubella and chickenpox (both parameters together cost approx. € 30) as well as the AMH value (approx. € 50).

Our first contact team will be happy to assist you in making the first steps of your Fertility Journey as pleasant and uncomplicated as possible. We are happy to answer any questions you may have by phone on +43 1 934 69 79.

Important note on data protection:

By submitting this form, you consent to the data you provide being stored in our system. In addition, by requesting a laboratory referral, you agree that the findings will be sent to our "Kinderwunschzentrum an der Wien" after completion.

Laboratory referral

Request form - laboratory referral

First & last name*

Date of birth*

Email address*

Telephone number*

Insurance number*

Insurance institution*

Address*

ZIP code and city*

I need a referral for ...*

hormonal assay incl. AMH (Anti-Mullerian Hormone)

hormonal assay without AMH

cycle independent parameters (Vitamin D, APC resistance, rubella / chicken pox antibodies)

complete referral with all parameters for the first consultation

Notes

Data protection*

This message will be sent to the Kinderwunschzentrum via email. I have read and accept the Data protection agreement, especially the chapter "contact form". I agree that the findings will be sent to the "Kinderwunschzentrum an der Wien" after completion.

Fields marked with * are mandatory fields.