Prior to shipping of donor sperm, our Purchaser Semen and Storage Agreement needs to be completed.
For Patients with a Partner or Spouse, we recommend both parties initial and sign the form. Enter both names and email addresses on the form. The Patient should initial and sign before submitting it to the Partner or Spouse for their initials and signature.
For single customers, simply leave the second Name and Email blank.
Upon submission of the completed form, you will receive an email confirmation and an emailed copy of the signed form to keep for your records.
The form can be signed and submitted electronically:
Please use the same email address you use to logon to your seattlespermbank.com account when signing any electronic forms. This helps us ensure the form is correctly assigned to your account.
Only Submit This Form One Time. It will be saved for future orders and shipments.
This form can also be printed, signed and faxed to: (206) 466-4696 or scanned and emailed to email@example.com.
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