How to Fill Out The Clinic Release Form
If samples are shipped to your home or picked up at our office please have a physician or other licensed healthcare provider sign our Clinical Release Form.
If you are a having your order shipped within NY State, this release form is required for all orders and can only be completed by your physician.
This form can be digitally signed by your physician, or printed, signed, and returned to us via fax at (206) 466-4696 or scanned and emailed to firstname.lastname@example.org.
We have three convenient ways for you and your physician to fill out the Clinic Release form:
- Email Clinical Release to your Provider
You can email your provider using the link above! Simply click it, then enter your physician’s email address in the popup!
- Download Clinical Release PDF
With this link you can download a PDF version of our Clinic Release form to print and fill.
- Online Form- Clinical Release
Our online Clinic Release form allows you to fill out the Clinic Release online!
You can also mail any of this signed paperwork to:
Seattle Sperm Bank
4915 25th Avenue NE, Ste 204
Seattle, WA 98105
Send the Clinic Release to a Physician’s Email
You can send the Clinic Release directly to your physician to fill out! Once you’re logged in to your account, you can select the link below. A popup will appear with an email input field- just add your physician’s email address and hit Submit!
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