Welcome patients of The Center for Reproductive Health at Kaiser Permanente. Below you will find the forms required to set up an account with ReproTech or, at the bottom, the forms needed to have your sperm, embryos or oocytes transferred back to The Center for Reproductive Health in Fremont.
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.
Also please note, when completing paperwork to have your specimens RETURNED to The Center for Reproductive Health, the Special Circumstance Release Documentation is only required for those individuals who have either tested reactive for a communicable disease or are missing some of the required testing results. The Specimen Transfer From RTL and Medical Information Release form will require your signatures in the presence of a notary.
We look forward to serving you.
Embryo
- D ACQ-100 Registration – All Tissues
- AC ACQ-100 Embryo Cryostorage Agreement – Single Client Depositor
- O ACQ-100 Embryo Cryostorage Agreement – Client Depositor Couple
- AU ACQ-100 Specimen Transfer to RTL and Medical Data Release Authorization
Semen/Testicular Tissue
- D ACQ-100 Registration – All Tissues
- N ACQ-100 Semen/Testicular Tissue Cryostorage Agreement
- AU ACQ-100 Specimen Transfer to RTL and Medical Data Release Authorization
Oocyte/Ovarian Tissue
- D ACQ-100 Registration – All Tissues
- AA ACQ-100 Oocyte/Ovarian Tissue Cryostorage Agreement
- AU ACQ-100 Specimen Transfer to RTL and Medical Data Release Authorization
Donor Tissue
- D ACQ-100 Registration – All Tissues
- AE ACQ-100 Donor Tissue Cryostorage Agreement – Semen or Oocyte
- AU ACQ-100 Specimen Transfer to RTL and Medical Data Release Authorization