Person 1 Date of Birth Person 2 Date of Birth Address Details Shipping Details Are you wanting to ship (select one or more) SpermEggsEmbryos Are these using donor sperm or egg? ---YesNo Sending Clinic (where the material is currently) Receiving Agency / Clinic (where the material is to be shipped to) Permission In order to facilitate efficient communication between the sending and receiving IVF clinics / agency and the selected couriers, I/we hereby consent to the release of my/our personal health information held by to Growing Families. I, authorize Growing Families to organise the administration and transportation of my biomaterial (oocytes, sperm) from to I understand that a 3rd party courier / freight organisation will be engaged, and that Growing Families is not liable for the actual transportation / delivery of the biomaterial. A copy of this form will be emailed to you within 1 business week requiring your signature and confirming that Growing Families will start working on this request. Please opt me in to receive the Growing Families Newsletter & occasional informative updates
