The below mentioned parties, who has previously undergone IVF treatments and thereby  obtained frozen fertilized eggs, hereby authorize you to thaw and use them for the treatment of our infertility.  
 
Date: ___________________  
 
 
The woman’s full name (block letters): ________________________________________ 
 
 
The woman’s signature __________________________  
 
 
CPR. number: _________________________________ 
 
 
The partner’s full name (block letters): _________________________________________  
 
 
The partner’s signature __________________________  
 
 
CPR. number: _________________________________  

The signed copy needs to be returned to The Fertility Department no later than the day after receiving your appointment.  
 
The least complicated way is to access through ‘MinSundhedsplatform’ www.MinSundhedsplatform.dk 

MinSundhedsplatform is an easy and  secure communication between patient and hospital 
 
If we do not have a signed copy of this document the department will not be able to treat you