Below are the forms that ReproTech requires your long-term storage patients to complete prior to cryopreservation for ReproTech account setup.
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Specimen Shipping Liability Protection is available exclusively to ReproTech clients through CNA Financial Corporation, a premier insurance broker in the U.S.
Donor Tissue
- D ACQ-100 Donor Tissue – Semen or Oocyte Registration
- AE ACQ-100 Donor Tissue Cryostorage Agreement – Semen or Oocyte
- AU ACQ-100 Specimen Transfer to RTL and Medical Data Release Authorization
Semen/Testicular Tissue
- D ACQ-100 Semen/Testicular Tissue Registration
- 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 Oocyte/Ovarian Tissue Registration
- AA ACQ-100 Oocyte/Ovarian Tissue Cryostorage Agreement
- AU ACQ-100 Specimen Transfer to RTL and Medical Data Release Authorization
Embryo
- D ACQ-100 Embryo Registration
- 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
All Tissues – Transfer FROM RTL
- BM DIS-100 Specimen Transfer from RTL and Medical Data Release Authorization – Embryo/Sperm/Oocytes/Testicular or Ovarian Tissue – Courier
- 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
- S DIS-100 Special Circumstance Release – Semen
- BC DIS-100 Special Circumstance Release – Oocyte/Ovarian Tissue
- AT DIS-100 Special Circumstance Release – Donor Tissue
- AG DIS-100 Special Circumstance Release – Embryo/Gestational Carrier
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.