Outreach Health Services Client Forms

Orders shipped to Canada are placed through our distributors. Please contact Outreach Health Services directly to place your semen order.

Other forms and brochures may be requested from our Client Service Specialists. Please contact us if you need assistance.

• Terms of Use Letter - This document explains what you can expect from our program and what we can expect from you when purchasing our semen and other services.

• International Patient Photo Agreement and Order Form- for those who live outside the US and want to order adult/Lifetime photos

• International Identity (ID) Option Patient Agreement- for those who live outside the US and   want to use an ID Option donor

• International Identity (ID) Option Birth Registration Form- for those outside the US and want to register the birth of a child from an ID Option donor

• Outreach Health Services Instructions for Semen Identification Thawing and Specimen Quality Standard

Forms/Policies in French

• Terms of Use Letter - Modalités de Outreach Health Services.

• International Identity (ID) Option Patient Agreement -Accord international d’identification du patient

• International Identity (ID) Option Birth Registration- Formulaire d’enregistrement de naissance Option d’identification internationale

• International Patient Photo Agreement and Order Form - Accord international de divulgation de photographies de patient et bon de commande

• Outreach Health Services Instructions for Semen Identification Thawing and Specimen Quality Standard Outreach Health Services Instructions: d'identification et de décongélation de sperme, et norme de qualité des spécimens

Physician Only Forms- click here

Important Policies

• CLI and Fairfax Cryobank limit the total number of births outside the US for any donor based on the application of several criteria. Specifically, a donor's sales will cease when either of the following criteria is reached:

  1. Maximum of 15 family units (children from the same donor living in one home) reported outside the US; OR

  2. Total number of units sold reaches our designated limit (actual numbers are not disclosed)

  3. Family units who have children by the same donor will be sold additional donor units, if available, as 'Sibling Pregnancies Only' units.

  4. In addition, we also monitor the reported location of births and limit the geographic distribution of a donor consistent with the guideline of the American Society of Reproductive Medicine (ASRM).

  5. In order to help us monitor the number of births associated with any donor, it is important that everyone be diligent in reporting births to us. Please go to the pregnancy reporting page for CLI  or pregnancy reporting page for Fairfax Cryobank or call us with your information.

  6. If a donor has reached his maximum limits on family units or total sales, then reactivation of that donor may be available for sibling pregnancies. (Reactivation means that a donor can be asked to provide additional samples after he has left the program. The donor must first agree to be reactivated and if he does the client agrees to pay all costs which typically exceed several thousand dollars.)

   

• Privacy Policy

Fairfax Cryobank Brochures available for download:

• Donor Sperm Services
• Donor Insemination: General Information

Cryogenic Laboratories, Inc Brochures available for download:

• Donor Sperm: Patient Information

• Donor Insemination: What You Need to Know

Monthly e-news

• To be added to our Fairfax Cryobank monthly e-news, please provide us your email address.

• To be added to our Cryogenic Laboratories monthly e-news, please provide your email address.

Video about our Donor Sperm Services

• View sample Video Clips here.