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.
The woman’s full name (block letters): ________________________________________
The woman’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.