Form Requirements

Below is a list of form requirements for each type of storage available at ReproTech. Please find the section on the type of storage you need for more information.

To download the forms you need, you must first
Create an Account
Then
Download Your Forms

NOTE:  The login credentials created here allow access to patient forms only.  For Customer Portal access, you must create a separate account.  Send an email to This email address is being protected from spambots. You need JavaScript enabled to view it. and include your full name, email address, address and phone number in the body of the email.  Your Portal login credentials will be emailed to you.


Each type of storage has different form requirements, see below.

Contact RTL to obtain copies of the following forms to open an account and to authorize the transfer of your semen specimens.

  1. Registration - This form gives us information about the patient and identifies the method of payment of fees.
  2. Semen Cryostorage Agreement - This form defines the terms and conditions of storage of cryopreserved semen and the conditions for release of semen specimens from storage.
  3. Specimen Transfer To RTL and Medical Data Release Authorization - This form obtains the patient’s consent for the release of medical data, as well as the consent to transfer the semen specimens to RTL for storage.
  4. Treatment History - This form gives us information on the patient’s medical/treatment history and the reason for semen cryobanking.
  5. Addendum to Semen Cryostorage Agreement - This form is necessary only for patients who have tested reactive for HIV, Hepatitis B, Hepatitis C, HTLV I&II, or other sexually transmitted diseases. This form defines additional terms and conditions of storage and shipping that apply to potentially infectious specimens.

Contact RTL to obtain copies of the following forms to open an account and to authorize the transfer of your embryos.

  1. Registration - This form gives us information about the patients and identifies the method of payment of fees.
  2. Embryo Cryostorage Agreement - This form defines the terms and conditions of storage of cryopreserved embryos and the conditions for release of embryos from storage. We have different versions for patient couples and single patients.
  3. Specimen Transfer To RTL and Medical Data Release Authorization - This form obtains the patients’ consent for the release of medical data, as well as the consent to transfer the embryos to RTL for storage.
  4. Addendum to Embryo Cryostorage Agreement - This form is necessary only for patients who have tested reactive for HIV, Hepatitis B, Hepatitis C, HTLV I&II, or other sexually transmitted diseases. This form defines additional terms and conditions of storage and shipping that apply to potentially infectious specimens.

Contact RTL to obtain copies of the following forms to open an account and to authorize the transfer of your oocytes.

  1. Registration - This form gives us information about the patients and identifies the method of payment of fees.
  2. Treatment History - This form gives us information on the patient’s medical/treatment history and the reason for oocyte storage (cryobanking).
  3. Oocyte Cryostorage Agreement - This form defines the terms and conditions of storage of cryopreserved oocytes and the conditions for release of eggs from storage.
  4. Specimen Transfer To RTL and Medical Data Release Authorization - This form obtains the patient's consent for the release of medical data, as well as the consent to transfer the oocytes to RTL for storage.
  5. Addendum to Oocyte Cryostorage Agreement - This form is necessary only for patients who have tested reactive for HIV, Hepatitis B, Hepatitis C, HTLV I&II, or other sexually transmitted diseases. This form defines additional terms and conditions of oocyte storage and shipping that apply to potentially infectious eggs.

Contact RTL to obtain copies of the following forms to open an account and to authorize the transfer of ovarian tissue.

  1. Registration - This form gives us information about the patients and identifies the method of payment of fees.
  2. Treatment History - This form gives us information on the patient’s medical/treatment history and the reason for ovarian tissue storage (cryobanking).
  3. Ovarian Tissue Cryostorage Agreement - This form defines the terms and conditions of storage of cryopreserved ovarian tissue.
  4. Specimen Transfer To RTL and Medical Data Release Authorization - This form obtains the patient's consent for the release of medical data, as well as the consent to transfer the ovarian tissue to RTL for storage.
  5. Addendum to Ovarian Tissue Cryostorage Agreement - This form is necessary only for patients who have tested reactive for HIV, Hepatitis B, Hepatitis C, HTLV I&II, or other sexually transmitted diseases. This form defines additional terms and conditions of ovarian tissue storage and shipping that apply to potentially infectious tissue.
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