S2d Consent and signature, single - Thawing of fertilized eggs

S2d Consent and signature, single - Thawing of fertilized eggs

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 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.

Redaktør