Forms

Client Forms

The following forms may be necessary for clients and/or partners before any order can be shipped out.

Purchaser Semen and Storage Agreement (ALL CLIENTS)
Clinic Release Form (shipments to clinics in the State of NY and the rare clinic that may require the form).
Non-Clinic Release Form (shipments to all non-medical addresses, such as a client’s home or workplace).
Informed Consent Form Please check your chosen donor’s webpage to see if the Informed Consent Form is required.

Purchaser Semen and Storage Agreement

You must fill out and complete the Purchaser Semen and Storage Agreement. This form may be completed online OR printed, signed and returned to us before we can ship your vials.

Instructions for Clients:

Complete form online PSSA Form
OR – Download the form from: PSSA Download.
Return to SSB either by email to forms@seattlespermbank.com or by fax to (206) 466-4696.

For Patients with a Partner or Spouse, we recommend both parties initial and sign the Purchaser Semen and Storage Agreement (PSSA) form. Enter both names and email addresses on the form. The Patient should initial and sign before submitting it to the Partner or Spouse for their initials and signature.

Please use the same email address you use to logon to your seattlespermbank.com account when signing any electronic forms. This helps us ensure the form is correctly assigned to your account.

Shipping to a clinic?

We may need you to have your physician / clinic complete the Clinic Release Form. This form may be completed online OR printed, signed, and returned to us before we can ship your vials.

This form is required for ALL NY State clinics / lab deliveries, and in rare cases, may be required for a clinic outside of NY State.

Instructions for Physician / Clinic

Complete form online Clinic Release Form
OR – Download the form from the Clinic Release form download link.
Your physician needs to fill out and sign the authorization form.
Return to SSB either by email to forms@seattlespermbank.com or by fax to (206) 466-4696.

Shipping to a non-medical address (such as your home) OR picking up at our office in Seattle?

Please have your physician / licensed medical professional complete the Non-Clinic (Residential) Release Form. This form may be completed online OR printed, signed, and returned to us before we can ship your vials.

Instructions for Physician / Clinic

Complete form online Non-Clinic Release Form
OR – Download the form from the Non-Clinic Release Form download link
Your physician needs to fill out and sign the authorization form.
Return to SSB either by email to forms@seattlespermbank.com or by fax to (206) 466-4696.

You can also mail any of this signed paperwork to:

Seattle Sperm Bank
4915 25th Avenue NE, Ste 204
Seattle, WA 98105