BioGenetics™ Corporation

Providing Donors of Diverse Ethnic Origins Worldwide with Assured Personal and Confidential Care

Documents and Fee

The following documents are in Portable Document Format (PDF), which maintains the layout of a page. To read and print the application forms, you must have Adobe Acrobat Reader, which is available for free from http://www.adobe.com.

Click on the following to download:

Fee Schedule
	Fee schedule for Cryopreserved Donor Sperm
Donor personal and family medical history and Donor personal lifestyle assessment (USD $12.00 fee applies per donor). Donor baby pictures are available at the donor’s discretion ( USD $12 fee per picture). Requisition Forms


	Physician Authorization

	Recipient Acknowledgement (Must be submitted with initial order/shipping request form. This document is valid for 12 consecutive months or if you change physician/clinic)

	Medical Provider Service Agreement for Cryobanked Donor Sperm (Must be submitted prior to initial order/shipping request form)

	Order Request and Confirmation (Must be submitted 48hrs prior to shipping date. This document can be emailed, faxed or mailed. This document must be submitted each time you place an order. This document may be used to cancel an order that has already been placed.)

	Cancellation of Order Placed by Phone

	Credit Card Authorization

	Record of Pregnancy Outcome Card

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