top of page
Log In
Home
About
Booking
Contact
FAQ
T & C
Monitoring System
TRANSPORT BOOKING FORM & CONSENT
Personal Information
Patient Full Name:
Date of birth
*
required
Patient Email:
Patient Mobile Number (WhatsApp):
Partner Information
Partner Full Name:
Date of birth
Exporting Clinic Information
Exporting clinic name:
Exporting clinic address:
Exporting clinic email address (for the lab)
Exporting clinics telephone number:
I confirm the exporting clinic details are correct
Importing Clinic Information
Importing clinic name:
Importing clinic address:
Importing clinic email address (for the lab)
Importing clinics telephone number:
I confirm the importing clinic details are correct
Sample Information
Type of samples
Select
Number of samples (Embryos):
Number of samples (eggs):
Number of samples (sperm):
Transport destination
Select
Delivery Type:
Select
Express delivery (+£50)
How did you hear about us
Transport Consent
Transport Consent: I/We authorize EmbryoPort embryologist to communicate with the exporting and importing IVF clinics to organize the transport of my/our Embryos / Eggs / Sperm samples and to be responsible for the transport process. We accept that Embryoport can’t guarantee that the transported human biological material will survive the transportation, nor can Embryoport be held responsible for any loss, damage or delay to the human biological material once they leave the care of the company or its agents. Embryoport accepts no responsibility for any abnormality or deficiency of any resulting child born as a consequence of the use of the human embryos and or gametes transported. I/We have read, acknowledge & accept Embryoport terms & conditions of trading (January 2021) or at www.embryoport.co.uk.
Disclosure Consent
I consent to pass my details to all relevant parties involved in the transport process
WhatsApp communication
I agree to communicate via whatsApp to be updated about the transport progress.
bottom of page
