Forms and Handouts

Medical Records

• PHI Authorization Form

Pharmacy List

• Pharmacy List

Treatment Consent Forms

Consent documents must be signed by the patient and partner (if applicable) prior to each treatment cycle. Consent documents may be returned in the office, faxed to (646) 962-0329 or emailed to crmdocs@med.cornell.edu.

Please feel free to contact the office by telephone with any questions: 

• Justine Witzke, PhD, MPH: (646) 962-3235
• Rodriq Stubbs, NP: (646) 962-3276
• Mitasha Joseph, RN, MPA: (646) 962-3382
• Amy Humphreys, MPH: (646) 962-3274

IVF 

• IVF Consent Packet
• Voicemail Authorization Consent

Fertility Preservation (Egg Freezing)

• Oocyte Cryopreservation
• Frozen Oocyte Thaw and Embryo Transfer Consent

Frozen Embryo Transfer

• Frozen Embryo Transfer Consent

Frozen Sperm Consents

• Anonymous Donor Sperm Consent
• Donor Sperm -- Subsequent Use Consent
• Partner Frozen Sperm Consent

Frozen Sperm- Andrology Laboratory Storage Consents

These documents are required for each transport of sperm vials from any outside facility. 

•  Consent to Store Male Partner Sample from another Facility
•  Consent to Store Anonymous Donor Sample
•  Consent to Store Directed Donor Sample

Handouts and Class Slides

IVF

•   IVF Class Slides

IVF Pre-Op Video

•  Pre-Op Video

Fertility Preservation

• Fertility Preservation Class Slides

Ovulation Induction

• Ovulation Induction Class Slides

Donor Egg Recipient Information

• Donor Egg Recipient Flow Sheet
• Genetic Testing Information

Donor Sperm

• Anonymous Donor Sperm Information Packet 
• Donor Sperm Banks