Order the Fertility Guide from the Fertility Physicians of Northern California

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Fertility Guide Request Form

Your Personal Guide to Fertility, created by Barbara Dehn, RN, contains helpful information in a guide that is easy to read and understand. Ms. Dehn is an award winning author and a regular on-air “women’s health expert” for NBC shows iVillageLive and In The Loop and a women’s health Nurse Practitioner in the Bay Area.

To request your copy of Your Personal Guide to Fertility, please provide the following information.

FPNC never loans or rents any of your contact information. Information mailed to you is discreet and does not indicate the contents.

First and Last Name:

Address:

City:

State/Province:

Zip:

Please call me. I would like to speak to an FPNC representative:

Phone:

Please add me to your email list for updates on fertility news and events:

Email:

Are you currently a patient at Fertility Physicians? Yes No

How did you first learn about Fertility Physicans of Northern California? (check as many as may apply)

Referrals
	Referred by my OB/GYN or physician
	(Please provide name of your physician)
	Referred by a friend
	Referred by insurance company
	Which company?
	Other referral
Internet
	FPNC.com website
	Search Site
	Which one?
	Listing on web linking to FPNC.com
	Which one?
	Other
Advertisement (Where did you see or hear an ad? Please mark all that apply.)
	Radio	Station?
	Television	Channel?
	Newspaper	Which one?
	Magazine	Which one?
	Calendar listing	Which one?
	Other Ad	Where?

We welcome your questions – please call us! 800-597-2234