Patient Paperwork
Please feel free to contact us with any questions regarding which forms you will need. Forms should be completed in their entirety and can be emailed to one of our front desk coordinators or faxed to the office. Electronic signatures are acceptable, so long as a copy of a valid government or state issued ID is submitted with the document.
New Patient Paperwork
- Registration form
- Privacy Practices and Acknowledgement of Receipt of Privacy Practices
- Storage/banking contract
- Intended Use
- Consent to send medical record to/from Family Fertility CryoBank
Transferring Storage TO Family Fertility CryoBank
- All of the “New Patient Paperwork” listed above
- Transfer your materials TO FFCB
- Tank Rental (Pick-Up)
- Tank Rental (Shipment)