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Storage account set-up
PRESERVE kit forms
Other forms


Completed, signed documents can be returned to CAN-AM at the following:
Scan/email to: info@canamcryo.com
Fax: 905-524-3936 or Toll free 1-877-772-6387
Mail: 102-1057 Main St. W., Hamilton, ON L8S 1B7
 


Storage account set-up


Blood Testing Request Form

Blood testing must be completed before sperm can be stored. Provide this list of required testing to your family doctor or oncologist to have testing completed before your first storage appointment.

DOWNLOAD PDF
 


Storage and Billing Agreements

Your contract with CAN-AM to store your banked sperm as a Client Depositor.

DOWNLOAD STORAGE AGREEMENT PDF  COMPLETE STORAGE AGREEMENT ONLINE


DOWNLOAD BILLING AGREEMENT PDF  COMPLETE BILLING AGREEMENT ONLINE
 


Information and Consent for use of Human Reproductive Material (HRM)

Under the Assisted Human Reproduction (AHR) Act of Canada (2004), Client Depositors must give written consent for reproductive use of their sperm. Please review the information sheet and then submit the completed Consent to CAN-AM.

DOWNLOAD PDF  COMPLETE AHR CONSENT ONLINE
 

Personal Health Information Protection (PHIP) Policy and Consent to Disclosure

Information about your personal health is protected under the Ontario PHIP Act (2004). To allow us to review results of testing required for storage, and to share the results of your sperm quality assessment with your doctor, we require your consent. Please review the Information sheet and then submit the completed Consent to CAN-AM.

DOWNLOAD PDF   COMPLETE PERSONAL HEALTH INFO CONSENT ONLINE

 


PRESERVE kit forms


PRESERVE Kit Instructions

Instructions to collect your sperm for personal banking, and ship them back to CAN-AM for freezing and storage.

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Specimen Collection Documentation

Complete the details of your sperm sample collection. You may upload a copy of one piece of identification by completing the form online. Or you may email a copy directly to info@canamcryo.com.

DOWNLOAD PDF   COMPLETE COLLECTION DOCUMENT ONLINE


Other forms


Consent for Release and Transfer of Stored Sperm

This form is for clients with sperm stored at CAN-AM who want to some or all of their sperm to another facility. Complete this consent and return to CAN-AM to transfer your sperm to your fertility clinic.

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Consent for the Disposal of Stored Sperm

This form is for clients with sperm stored at CAN-AM who want to terminate their storage account and discard their sperm. Complete this consent and return to CAN-AM to dispose of your unneeded stored sperm.

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