Embryoport - IVF Courier - Embryo Transporter

Booking and Consent

Patient name = female name if transporting embryos, eggs or donor sperm

Patient name = male name if transporting own sperm

Clinic email should be the email address for the embryologists, laboratory or transport patient coordinator

TRANSPORT BOOKING FORM & CONSENT

Patient Full Name:

Date of birth

Patient Email:

Patient Mobile Number including country code (WhatsApp):

Partner Full Name:

Date of birth:

Exporting clinic name:

Exporting clinic address:

Exporting clinic email address (for the lab)

Exporting clinics telephone number including country code:

Importing clinic name:

Importing clinic address:

Importing clinic email address:

Importing clinic telephone number:

Type of samples

Number of samples (Embryos)

Number of samples (eggs)

Number of samples (sperm)

Transport destination

How did you hear about us

Payment option

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.

TRANSPORT BOOKING FORM & CONSENT

CONTACT

+447857950009
transport@embryoport.co.uk

ADDRESS

Embryoport | IVF TRANSPORTER
142 Blackbrook Lane, Bromley
Kent - UK
BR1 2HP

OFFICE HOURS

TRANSPORT BOOKING FORM & CONSENT

CONTACT

+447857950009transport@embryoport.co.uk

ADDRESS

Embryoport | IVF TRANSPORTER142 Blackbrook Lane, BromleyKent - UKBR1 2HP

OFFICE HOURS

+447857950009
transport@embryoport.co.uk

Embryoport | IVF TRANSPORTER
142 Blackbrook Lane, Bromley
Kent - UK
BR1 2HP