Patient Forms

PATIENT FORM DOWNLOAD PAGE
Note: Some of these forms require notarization to protect your samples.

Sperm Cryopreservation (Freezing) Information, Consent and Legal Statement. You may download and review this form prior to your appointment. You can sign this and bring it with you, or sign the forms at your clinic appointment.
Cryopreservation information: Cryo Info
Detailed information about methods and future uses of frozen sperm: Cryo Uses
Consent and Legal Statement (required to freeze sperm): Consent Cryo

Forms to request shipping of frozen samples FROM the MFL to another lab or clinic.
Release of Private Health Information Form (required): PHI Release
Consent to ship sperm FROM the MFL: Ship From MFL

Forms to allow shipping of your frozen sperm TO the MFL from another lab or clinic.
          (Not for Donor Sperm, see below).  
Consent to ship sperm TO the MFL: Ship To MFL
Legal Statement regarding control and responsibilities for your stored samples: Legal Statement

Form for DONOR SPERM shipping TO the MFL from a Sperm Bank or other lab or clinic. This applies to Anonymous or Directed Donor sperm only. Arrangements must be made with a provider for your inseminations. Handling/administration fee applies for patients who are not receiving insemination services from UW Medicine. FDA-required paperwork must accompany the samples. Please contact us prior to shipment so we may make arrangements with the shipping lab. 
Consent and Legal Statement for Receipt of Donor Sperm: Consent Donor Receipt