Pollin IVF Funding Consideration

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Pollin IVF Funding Consideration

Thank you for your interest in Pollin’s Funded IVF Program. Please complete the following form to be considered for placement on our funding waitlist.

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Your name as it appears on your Ontario Health Card:

First Name

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Last Name

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Eligibility (check all that apply)

I am under the age of 43 years

I have not completed a funded IVF cycle at another clinic

I have not signed a funding agreement or consent at another clinic

Readiness (check one)

I am prepared to start a cycle within the next 3 months

I am not prepared to start a cycle within the next 3 months

Cycle information (complete all fields that apply):*

Last Menstrual Period (LMP):

dd-mm-yyyy

Expected Next Menstrual Period (NMP):

dd-mm-yyyy

Unknown (check box if you do not have a cycle)

I do not have a cycle

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What Happens Next

Our physicians will review your chart over the coming weeks.

Your care team will contact you directly if any updated testing or appointments are required.

Placement on the waitlist does not guarantee funding. Selection and timing depend on medical eligibility, program rules, and clinic capacity.