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 Liability Protection is available exclusively to ReproTech clients through CNA Financial Corporation, a premier insurance broker in the U.S.
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Reproductive Tissue – Semen, Testicular Tissue, Oocytes, Ovarian Tissue – New Patients
Embryo – New Patients
All Tissues – Transfer FROM ReproTech – Returning to Clinic
- Transfer FROM RTL Auth and Medical Data Release T01
- Transfer FROM RTL Auth and Med Release – Research/Continued Storage/Therapeutic Use T02
- Special Circumstance Release – Embryos T10
- Special Circumstance Release – Oocyte Ov Tissue T06
- Special Circumstance Release – Semen T11
- Special Circumstance Release – Donor Embryos T09
- Special Circumstance Release – Donor Tissue (semen & oocytes)T08
- Special Circumstance Release – Embryo Gestational Carrier T07
Lab Staff form
- Specimen Transfer Data – FILLABLE – DIS-050 Fillable version – This form is completed by lab staff, not patients