Indiana Fertility Institute

Below are the forms that ReproTech requires your long-term storage patients to complete prior to cryopreservation for ReproTech account setup. 

The “Transfer FROM RTL” forms at the bottom must be completed for patients’ tissues to be transferred back to your clinic. Please note that when returning specimens to your clinic, the Special Circumstance Release Documentation is also only required for those individuals who have either tested reactive for a communicable disease or are missing some of the required testing.

The Specimen Transfer From RTL and Medical Information Release form will require patient signatures in the presence of a notary.

Specimen Shipping Insurance is available exclusively to ReproTech clients through CNA Financial Corporation, a premier insurance broker in the U.S.

Please note: a separate Addendum to Cryostorage Agreement for potentially infectious clients is no longer required for new accounts. We have incorporated this language into our new storage agreements as of 7/31/20.

Embryo

Semen/Testicular Tissue

Oocyte/Ovarian Tissue

Donor Tissue

All Tissues – Transfer FROM RTL