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