Welcome patients of Family Fertility Center in Bethlehem. Below you will find the forms required to set up a specimen storage account with ReproTech, and at the bottom, the forms needed to have your sperm, embryos or oocytes transferred back to Family Fertility Center.
If you are a patient who will be storing cryopreserved semen, embryos or oocytes, please download and complete the applicable forms indicated below and provide to Family Fertility Center.
Please note that the Specimen Transfer From RTL and Medical Information Release form, at the bottom, is required upon RETURN of your specimens to Family Fertility Center for ART procedures. This Transfer FROM RTL forms require patient signatures (couples must BOTH sign) in the presence of a Notary Public.
We look forward to serving you.
Specimen Shipping Liability Protection is available exclusively to ReproTech clients through CNA Financial Corporation, a premier insurance broker in the U.S.
Reproductive Tissue – Semen, Testicular Tissue, Oocytes, Ovarian Tissue – New Patients
Embryo – New Patients
All Tissues – Transfer FROM ReproTech – Returning to Clinic
These forms must be notarized. If a couple, BOTH patients must sign in the presence of a notary.