Provider Referral Form 

If you are a provider (or inquiring on behalf of a provider's office) and would like to contact us, refer a patient, request materials, request a lunch and learn, or if you simply have a question for one of our physicians - please complete the form below.

You may also call our Front Desk at 206-515-0000 and they will be happy to direct your question to the most appropriate staff member. For all Andrology Lab related questions, you may call the lab directly at 206-515-0002 or fax your Andrology Order Forms to 206-515-0003.


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We had an excellent experience!  Very quick response to questions/emails.  Very professional.  The clinic is like a well oiled machine.  Everybody is very friendly and went out of their way to make sure we had a great experience.

2015 Anonymous Donor Program Survey
Pacific NW Fertility Patient

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