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.

Donor Tissue

• AE ACQ-100 Donor Tissue Cryostorage Agreement – Semen/Oocyte
• D ACQ-100 Donor Tissue – Semen or Oocyte Registration
• AU ACQ-100 Specimen Transfer to RTL and Medical Data Release Authorization
• Spanish:
• AES ACQ-100 Acuerdo Para La Criopreservacion De Tejido Donado
• DS ACQ-100 Registro – Tejido Donado Semen u Ovulo
•  AUS ACQ-100 Autorizacion Para El Traslado De Muestras a RTL y Para La Entrega De Datos Medicos – Correo

Semen/Testicular Tissue

• D ACQ-100 All Tissues – Registration
• N ACQ-100 Semen/Testicular Tissue Cryostorage Agreement
• AU ACQ-100 Specimen Transfer to RTL and Medical Data Release Authorization
• Spanish:
• DS ACQ-100 Registro – Embrion/Esperma/Oocitos/Tejido Testiculr u Ovarico
• NS ACQ-100 Acuerdo Para El Crioalmacenamiento De Semen/Tejido Testicular
• AUS ACQ-100 Autorizacion Para El Traslado De Muestras a RTL y Para La Entrega De Datos Medicos – Correo

Oocyte/Ovarian Tissue

• AA ACQ-100 Oocyte/Ovarian Tissue Cryostorage Agreement
• D ACQ-100 All Tissues – Registration
• AU ACQ-100 Specimen Transfer to RTL and Medical Data Release Authorization
• Spanish:
• AAS ACQ-100 Acuerdo Para La Criopreservacion De Oocito/Tejido Ovarico
• DS ACQ-100 Registro – Embrion/Esperma/Oocitos/Tejido Testiculr u Ovarico
• AUS ACQ-100 Autorizacion Para El Traslado De Muestras a RTL y Para La Entrega De Datos Medicos – Correo

Embryo

• D ACQ-100 All Tissues – Registration
• O ACQ-100 Embryo Cryostorage Agreement – Client Depositor Couple
• AU ACQ-100 Specimen Transfer to RTL and Medical Data Release Authorization
• Spanish:
• DS ACQ-100 Registro Embrion/Esperma/Oocitos/Tejido Testiculr u Ovarico
• OS ACQ-100 Acuerdo Para El Crioalmacenamiento De Embriones – Pareja De Clientes Depositantes
• ACS ACQ-100 Acuerdo Para El Crioalmacenamiento De Embriones – Embrión Cliente Depositante Solo
• AUS ACQ-100 Autorizacion Para El Traslado De Muestras a RTL y Para La Entrega De Datos Medicos – Correo

All Tissues – Transfer FROM RTL

• BJ DIS-100 Specimen Transfer from RTL and Medical Data Release Authorization – Embryo/Sperm/Oocytes/Testicular or Ovarian Tissue
• BO DIS-100 Specimen Transfer from RTL and Medical Data Release Authorization – Research/Continued Storage/Therapeutic Use – Courier
• R DIS-100 Special Circumstance Release – Embryo
• BC DIS-100 Special Circumstance Release – Oocyte/Ovarian Tissue
• S DIS-100 Special Circumstance Release – Semen
• AT DIS-100 Special Circumstance Release – Donor Tissue
• AG DIS-100 Special Circumstance Release – Embryo/Gestational Carrier
• Spanish:
• BJS DIS-100 Autorizacion Para El Traslado De Muestras Deside RTL y Para La Entrega De Datos Medicos – Embrion/Esperma/Oocitos/Tejido Testiculr u Ovarico

Note: We have discontinued our Informed Consent forms. The consent language has now been incorporated into our BJ DIS-100 Specimen Transfer From RTL and Medical Data Release Authorization.