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FCLab Cryostorage

Cryostorage Registration

Request

Choose the request you need to start. Existing patients can request discard or transfer-out from this portal.

Required Stripe processing fee: Discard $50 / Transfer-out $150 This fee covers administrative handling, documentation review, storage coordination, chain-of-custody processing, and transfer/disposal logistics. It will be collected securely through Stripe before the request is finalized.
Client Information
Client Contact Information

We will text this number a one-time verification code through Twilio.

Client Identity Verification
Choose an existing photo or PDF

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Supporting Documents

Optional documents may include a death certificate, marriage certificate, legal authorization documents, identity verification documents, or other supporting documentation.

Accepted file types: PDF, JPG, PNG, DOC, DOCX. Up to 5 files, 10 MB each.

    Current Storage / Origin Location

    Enter the facility or location name and its ZIP code separately when known.

    Specimen / Material Type

    Select one reproductive material type. Partner information, partner ID, and partner signature are required for Embryo(s).

    Future Disposition: Death, Divorce, or Separation
    a) In the event of the death of the Client, I/we wish the Reproductive Material(s) to be: *
    Please select one option for death of client.
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    b) In the event of the death of the Partner, we wish the Reproductive Material(s) to be: *
    Please select one option for death of partner.
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    c) If applicable, in the event of both the deaths of the Client and Partner, we wish the Reproductive Material(s) to be: *
    Please select one option for death of both.
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    d) If applicable, in the event of the Client and Partner's divorce or separation, we wish the Reproductive Material(s) to be: *
    Please select one option for divorce/separation.
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Future Disposition Preferences

    e) In the event I/we notify FCLAB &/or Alpha Fertility in writing that I/we are unable to decide/agree on the future disposition of Reproductive Material(s) we wish the Reproductive Material(s) to be: *

    Please select one option for this disposition scenario.
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):

    f) I/We agree that in the event I/we fail to make one annual payment for storage, the Reproductive Material(s) will be: *

    Please select one option for this disposition scenario.
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):

    g) I/We understand that the Reproductive Material(s) will be stored for a time not to exceed the normal reproductive life of the Client (age 50 for females, age 65 for males). At that time I/we wish the Reproductive Material(s) to be: *

    Please select one option for this disposition scenario.
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):

    h) In the event I/we are no longer receiving assisted reproductive technology treatment and we have failed to inform FCLAB &/or Alpha Fertility of our current address and telephone number for a period of one (1) year I/we wish the Reproductive Material(s) to be: *

    Please select one option for this disposition scenario.
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Client initials:
    Partner initials (if applicable):
    Signatures and Authorization

    Draw with touch, a mouse, or a pen. Keyboard: focus the signature area, press Enter to start, use the arrow keys to draw, then press Enter to finish. Delete clears it.

    Review and Continue

    Your entries are ready for a final review before verification and any applicable payment.