Astrological Data Collection Form

IVF Conception & Childbirth Astrological Research Study आईवीएफ गर्भधारण एवं प्रसव पर ज्योतिषीय अनुसंधान अध्ययन

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This form collects astrological and medical data for academic research on IVF conception and childbirth.

यह फॉर्म आईवीएफ गर्भधारण एवं प्रसव पर ज्योतिषीय एवं चिकित्सीय डेटा संग्रह हेतु शैक्षिक अनुसंधान के लिए है।

🔒 All data is strictly confidential

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Mother

👨

Father

💍

Marriage

🔬

IVF

👶

Children

📋

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Fields marked with * are compulsory. Please provide complete birth details of the mother and father, along with the date of marriage.
* चिन्हित फ़ील्ड अनिवार्य हैं। कृपया माता-पिता की जन्म जानकारी एवं विवाह तिथि प्रदान करें।

👩

Mother's Details

माता की जन्म जानकारी

Date of Birth *

Time of Birth *

Place of Birth *

Any known reproductive or medical condition

👨

Father's Details

पिता की जन्म जानकारी

Date of Birth

Time of Birth

Place of Birth

Any known fertility or medical issue

💍

Marriage Details

विवाह विवरण

Date of Marriage

🔬

IVF Cycle Details

कृपया सभी आईवीएफ प्रयासों का विस्तृत विवरण दें (सफल एवं असफल)

Cycle 1

Month / Year

Exact Date (if known)

Result

Reason for IVF

IVF Type

Medical Complications

👶

Children Conceived Through IVF

आईवीएफ से जन्मे बच्चों का विवरण

Child 1

Date of Birth

Time of Birth

Place of Birth

Gender

Mode of Delivery

Associated IVF Cycle

Any complications at birth

🤝

Adopted Child Details

गोद लिए बच्चे का विवरण (यदि लागू हो)

Have you adopted a child?

📋

Additional Information

अतिरिक्त जानकारी

Astrological Remedies Performed

Start Month / Year

Duration

Perceived Effect

Any miscarriage history?

If Yes, please describe

Other relevant observations

By submitting, you confirm all information is accurate and consent to its use for research purposes.