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Rocky Mountain Center for Reproductive Medicine

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

Specimen Shipping Insurance is available exclusively to ReproTech clients through CNA Insurance Co. Ltd.

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

Lab Staff form:

  • B DIS-050 Specimen Transfer Data – Fillable version – This form must be completed by lab staff, not patients