Reproductive Medicine Institute

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 and will require patient signatures in the presence of a notary.
 
Specimen Shipping Liability Protection is available exclusively to ReproTech clients through CNA Financial Corporation, a premier insurance broker in the U.S.
 
Each time you access this webpage, please clear your browser cache to ensure you are viewing the most recent version of our forms. Learn how to clear your cache: https://its.uiowa.edu/support/article/719
 
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.

 
Lab Staff form