Forms and Agreements

Origin Forms and Agreements

Digital Order Form - When complete, please email to [email protected]

Donor Specimen Purchase and Terms of Use Agreement

Donor Specimen Shipment Information for the Patient

Andrology Referral Form

 

 

Fairfax and CLI Forms

Fairfax and CLI Physician Terms of Use - English

Fairfax and CLI Physician Terms of Use - French

Fairfax and CLI Canadian Terms of Use - English (On-Line Submission)

Fairfax and CLI Canadian Terms of Use - English (Document)

Fairfax and CLI Canadian Terms of Use - French (On-Line Submission)

Fairfax and CLI Canadian Terms of Use - French (Document)

Instructions for Semen Identification, Thawing, and Specimen Quality Standards - English

Instructions for Semen Identification, Thawing, and Specimen Quality Standards - French

Pregnancy Pledge Verification Form

Identity (ID) Option Birth Registration

Specimen Quality Complaint