Pregnancy & Birth Reporting At Sussex Sperm Bank

Thank you for completing our pregnancy and birth report form. Please return to this page with any updates regarding your pregnancy.

The information you provide is kept strictly confidential. This report will only be used to record children born from a particular donor, and to track for the purpose of birth limits.

If you have any questions, someone from our lab is always available to assist you. Please feel free to call us at 01273 620165 or send an email to [email protected].

Are you a patient or a clinic?(Required)

Type of Report:(Required)

Person Reporting:(Required)

First Last

Patient Name:(Required)

Patient DOB:(Required)

Clinic Name:(Required)

Patient Postal Code:(Required)

Clinic Code:(Required)

Country:(Required)

Patient Email Address:(Required)

Clinic Email Address:(Required)

Name of the treating clinic:(Required)

This field is hidden when viewing the form

Your Email: (Deprecated and hidden)

Clinic Patient Code/ID:(Required)

Donor Name/Number:(Required)

Method of insemination:(Required)

Number of vials used for insemination:

How many insemination cycles were performed?

Estimated Date of Treatment:(Required)

Treatment Outcome:(Required)

Samples Remaining:(Required)

Embryos Stored:(Required)

Number of Embryos:(Required)

Due Date / Delivery Date:(Required)

Number of Children

Number of boys:

Number of girls:

Birth Height (centimetres):

Birth Weight (kilograms):

Name of Child:

Comments:

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We are closed for the holidays starting on 25.12.24. We are reopening on 02.01.25.

Pregnancy & Birth Reporting At Sussex Sperm Bank

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