{"id":27472,"date":"2015-06-12T09:28:50","date_gmt":"2015-06-12T09:28:50","guid":{"rendered":"https:\/\/fairfaxcryobank.com\/pregnancy-report-form"},"modified":"2025-06-04T05:35:49","modified_gmt":"2025-06-04T09:35:49","slug":"pregnancy-report-form","status":"publish","type":"page","link":"https:\/\/fairfaxcryobank.com\/cn\/pregnancy-report-form","title":{"rendered":"\u598a\u5a20\u62a5\u544a"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><strong>Congratulations!<\/strong><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>We appreciate you reporting your pregnancy to Fairfax Cryobank!<\/strong><\/h3>\n\n\n\n<div class=\"sys-preg-form-cnt\" style=\"padding-top: 0;\">\n<p>Thank you for taking the time to complete this form to report your pregnancy using a Fairfax Cryobank donor. This helps us keep our records up-to-date for future Fairfax Families.&nbsp;<\/p>\n<p><em>Please do not report a pregnancy with this online form between 11pm and 2 am EST, as our system is updated during that time.<\/em><\/p>\n<p>If you used an ID donor, you will also need to complete the <a class=\"blue1\" href=\"https:\/\/fairfaxcryobank.com\/identity-id-birth-registration-form\" target=\"_blank\" rel=\"noopener noreferrer\">ID Birth Registration form<\/a> to allow your child to have the option to obtain donor information on or after their 18th birthday. For a pregnancy by an ID donor, we encourage you to fill out the form below but it will not be a substitute for completing the registration paperwork after birth. You can always call Client Services at 800-338-8407 to assist you.<\/p>\n<p>See our <a class=\"blue1 a3\" href=\"https:\/\/fairfaxcryobank.com\/limitations-on-donor-births\">Policy on Limiting Donor Births<\/a> to see when donors are stopped.<\/p>\n<p><em>* Indicates required field<\/em><\/p>\n<form method=\"post\" id=\"preg_form\" novalidate=\"novalidate\">\n<div class=\"form-cnt\">\n<div>\n* Order\/Invoice No. <input id=\"oder_no\" name=\"oder_no\" size=\"10\" maxlength=\"10\" type=\"text\">\n<br>\n<span style=\"font-size:13px\">(Obtained at time order placed. Call us or <a href=\"https:\/\/www.websitealive2.com\/1769\/rRouter.asp?groupid=1769&amp;websiteid=320&amp;departmentid=2903&amp;dl=http%3A\/\/https:\/\/fairfaxcryobank.com\/PregnancyReport.shtml\" target=\"_blank\" rel=\"noopener noreferrer\">click to chat<\/a> if you need this information.)<\/span>\n<\/div>\n<div>\n* Donor No. <input id=\"donor_no\" name=\"donor_no\" size=\"10\" maxlength=\"10\" required=\"\" aria-required=\"true\" type=\"text\">\n<\/div>\n<div class=\"label-list\">\nPreparation Type\n<label><input name=\"prep_type\" value=\"ICI\" type=\"radio\"> ICI<\/label>\n<label><input name=\"prep_type\" value=\"IUI\" type=\"radio\"> IUI<\/label>\n<label><input name=\"prep_type\" value=\"IVF\" type=\"radio\"> IVF<\/label>\n<label><input name=\"prep_type\" value=\"IUI ART\" type=\"radio\"> IUI ART<\/label>\n<label><input name=\"prep_type\" value=\"ICI ART\" type=\"radio\"> ICI ART<\/label>\n<label><input name=\"prep_type\" value=\"\" checked=\"\" type=\"radio\"> Unsure<\/label>\n<\/div>\n<div>\n<table>\n<tbody><tr>\n<td width=\"110px\" valign=\"top\">* Pregnancy<\/td>\n<td>\n<div class=\"preg-type-item\">\n<label><input id=\"preg_type_bio\" name=\"preg_type\" value=\"Biochemical\" required=\"\" aria-required=\"true\" type=\"radio\">Biochemical (Positive pregnancy test)<\/label>\n<div class=\"preg-type-item-details label-list preg-type-item-details-yes\">\n<div>\nPregnancy Ongoing?\n<label><input id=\"bio_pregnancy_yes\" name=\"bio_pregnancy\" value=\"Yes\" checked=\"\" type=\"radio\"> Yes<\/label>\n<label><input id=\"bio_pregnancy_no\" name=\"bio_pregnancy\" value=\"No\" type=\"radio\"> No<\/label>\n<\/div>\n<div class=\"due-date\">\nDue Date (MM\/DD\/YYYY) <input id=\"bio_duedate\" name=\"bio_duedate\" size=\"10\" maxlength=\"10\" class=\"birth-date hasDatepicker\" type=\"text\">\n<p class=\"hint\">Please report the birth of this pregnancy to us using this same online form. We carefully track births and limit the number of offspring for each donor.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"preg-type-item\">\n<label><input id=\"preg_type_clin\" name=\"preg_type\" value=\"Clinical\" type=\"radio\">Clinical&nbsp;(Positive pregnancy test AND sonogram showing a fetal heartbeat)<\/label>\n<div class=\"preg-type-item-details label-list preg-type-item-details-yes\">\n<div>\nPregnancy Ongoing?\n<label><input id=\"clin_pregnancy_yes\" name=\"clin_pregnancy\" value=\"Yes\" checked=\"\" type=\"radio\"> Yes<\/label>\n<label><input id=\"clin_pregnancy_no\" name=\"clin_pregnancy\" value=\"No\" type=\"radio\"> No<\/label>\n<\/div>\n<div class=\"due-date\">\nDue Date (MM\/DD\/YYYY) <input id=\"clin_duedate\" name=\"clin_duedate\" size=\"10\" maxlength=\"10\" class=\"birth-date hasDatepicker\" type=\"text\">\n<p class=\"hint\">Please report the birth of this pregnancy to us using this same online form. We carefully track births and limit the number of offspring for each donor.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"preg-type-item\">\n<label><input id=\"preg_type_birth\" name=\"preg_type\" value=\"Birth\" type=\"radio\">Birth&nbsp;<\/label>\n<div class=\"preg-type-item-details\">\n<div>\nBirth Date (MM\/DD\/YYYY) <input name=\"birth_date\" size=\"10\" maxlength=\"10\" class=\"birth-date hasDatepicker\" id=\"dp1535613851339\" type=\"text\">\n<\/div>\n<div>\nNo. of Babies Born <input name=\"birth_no\" size=\"2\" maxlength=\"2\" value=\"1\" type=\"text\">\n<\/div>\n<\/div>\n<\/div>\n<label for=\"preg_type\" class=\"error\" style=\"display: none;\"><\/label>\n<\/td>\n<\/tr>\n<\/tbody><\/table>\n<\/div>\n<div>\n* Location where insemination took place\n<div class=\"loc-cnt\">\n<div class=\"loc-select\">\n<select id=\"location_country\" name=\"location_country\">\n<option value=\"\">Select Country<\/option>\n<option value=\"AF\">Afghanistan<\/option>\n<option value=\"AX\">\u00c5land Islands<\/option>\n<option value=\"AL\">Albania<\/option>\n<option value=\"DZ\">Algeria<\/option>\n<option value=\"AS\">American Samoa<\/option>\n<option value=\"AD\">Andorra<\/option>\n<option value=\"AO\">Angola<\/option>\n<option value=\"AI\">Anguilla<\/option>\n<option value=\"AQ\">Antarctica<\/option>\n<option value=\"AG\">Antigua And Barbuda<\/option>\n<option value=\"AR\">Argentina<\/option>\n<option value=\"AM\">Armenia<\/option>\n<option value=\"AW\">Aruba<\/option>\n<option value=\"AU\">Australia<\/option>\n<option value=\"AT\">Austria<\/option>\n<option value=\"AZ\">Azerbaijan<\/option>\n<option value=\"BS\">Bahamas<\/option>\n<option value=\"BH\">Bahrain<\/option>\n<option value=\"BD\">Bangladesh<\/option>\n<option value=\"BB\">Barbados<\/option>\n<option value=\"BY\">Belarus<\/option>\n<option value=\"BE\">Belgium<\/option>\n<option value=\"BZ\">Belize<\/option>\n<option value=\"BJ\">Benin<\/option>\n<option value=\"BM\">Bermuda<\/option>\n<option value=\"BT\">Bhutan<\/option>\n<option value=\"BO\">Bolivia<\/option>\n<option value=\"BA\">Bosnia And Herzegovina<\/option>\n<option value=\"BW\">Botswana<\/option>\n<option value=\"BV\">Bouvet Island<\/option>\n<option value=\"BR\">Brazil<\/option>\n<option value=\"IO\">British Indian Ocean Territory<\/option>\n<option value=\"BN\">Brunei Darussalam<\/option>\n<option value=\"BG\">Bulgaria<\/option>\n<option value=\"BF\">Burkina Faso<\/option>\n<option value=\"BI\">Burundi<\/option>\n<option value=\"KH\">Cambodia<\/option>\n<option value=\"CM\">Cameroon<\/option>\n<option value=\"CA\">Canada<\/option>\n<option value=\"CV\">Cape Verde<\/option>\n<option value=\"KY\">Cayman Islands<\/option>\n<option value=\"CF\">Central African Republic<\/option>\n<option value=\"TD\">Chad<\/option>\n<option value=\"CL\">Chile<\/option>\n<option value=\"CN\">China<\/option>\n<option value=\"CX\">Christmas Island<\/option>\n<option value=\"CC\">Cocos (keeling) Islands<\/option>\n<option value=\"CO\">Colombia<\/option>\n<option value=\"KM\">Comoros<\/option>\n<option value=\"CG\">Congo<\/option>\n<option value=\"CD\">Congo, The Democratic Republic Of The<\/option>\n<option value=\"CK\">Cook Islands<\/option>\n<option value=\"CR\">Costa Rica<\/option>\n<option value=\"CI\">C\u00d4te D&#8217;ivoire<\/option>\n<option value=\"HR\">Croatia<\/option>\n<option value=\"CU\">Cuba<\/option>\n<option value=\"CY\">Cyprus<\/option>\n<option value=\"CZ\">Czech Republic<\/option>\n<option value=\"DK\">Denmark<\/option>\n<option value=\"DJ\">Djibouti<\/option>\n<option value=\"DM\">Dominica<\/option>\n<option value=\"DO\">Dominican Republic<\/option>\n<option value=\"EC\">Ecuador<\/option>\n<option value=\"EG\">Egypt<\/option>\n<option value=\"SV\">El Salvador<\/option>\n<option value=\"GQ\">Equatorial Guinea<\/option>\n<option value=\"ER\">Eritrea<\/option>\n<option value=\"EE\">Estonia<\/option>\n<option value=\"ET\">Ethiopia<\/option>\n<option value=\"FK\">Falkland Islands (malvinas)<\/option>\n<option value=\"FO\">Faroe Islands<\/option>\n<option value=\"FJ\">Fiji<\/option>\n<option value=\"FI\">Finland<\/option>\n<option value=\"FR\">France<\/option>\n<option value=\"GF\">French Guiana<\/option>\n<option value=\"PF\">French Polynesia<\/option>\n<option value=\"TF\">French Southern Territories<\/option>\n<option value=\"GA\">Gabon<\/option>\n<option value=\"GM\">Gambia<\/option>\n<option value=\"GE\">Georgia<\/option>\n<option value=\"DE\">Germany<\/option>\n<option value=\"GH\">Ghana<\/option>\n<option value=\"GI\">Gibraltar<\/option>\n<option value=\"GR\">Greece<\/option>\n<option value=\"GL\">Greenland<\/option>\n<option value=\"GD\">Grenada<\/option>\n<option value=\"GP\">Guadeloupe<\/option>\n<option value=\"GU\">Guam<\/option>\n<option value=\"GT\">Guatemala<\/option>\n<option value=\"GG\">Guernsey<\/option>\n<option value=\"GN\">Guinea<\/option>\n<option value=\"GW\">Guinea-bissau<\/option>\n<option value=\"GY\">Guyana<\/option>\n<option value=\"HT\">Haiti<\/option>\n<option value=\"HM\">Heard Island And Mcdonald Islands<\/option>\n<option value=\"HN\">Honduras<\/option>\n<option value=\"HK\">Hong Kong<\/option>\n<option value=\"HU\">Hungary<\/option>\n<option value=\"IS\">Iceland<\/option>\n<option value=\"IN\">India<\/option>\n<option value=\"ID\">Indonesia<\/option>\n<option value=\"IR\">Iran, Islamic Republic Of<\/option>\n<option value=\"IQ\">Iraq<\/option>\n<option value=\"IE\">Ireland<\/option>\n<option value=\"IM\">Isle Of Man<\/option>\n<option value=\"IL\">Israel<\/option>\n<option value=\"IT\">Italy<\/option>\n<option value=\"JM\">Jamaica<\/option>\n<option value=\"JP\">Japan<\/option>\n<option value=\"JE\">Jersey<\/option>\n<option value=\"JO\">Jordan<\/option>\n<option value=\"KZ\">Kazakhstan<\/option>\n<option value=\"KE\">Kenya<\/option>\n<option value=\"KI\">Kiribati<\/option>\n<option value=\"KP\">Korea, Democratic People&#8217;s Republic Of<\/option>\n<option value=\"KR\">Korea, Republic Of<\/option>\n<option value=\"KW\">Kuwait<\/option>\n<option value=\"KG\">Kyrgyzstan<\/option>\n<option value=\"LA\">Lao People&#8217;s Democratic Republic<\/option>\n<option value=\"LV\">Latvia<\/option>\n<option value=\"LB\">Lebanon<\/option>\n<option value=\"LS\">Lesotho<\/option>\n<option value=\"LR\">Liberia<\/option>\n<option value=\"LY\">Libyan Arab Jamahiriya<\/option>\n<option value=\"LI\">Liechtenstein<\/option>\n<option value=\"LT\">Lithuania<\/option>\n<option value=\"LU\">Luxembourg<\/option>\n<option value=\"MO\">Macao<\/option>\n<option value=\"MK\">Macedonia, The Former Yugoslav Republic Of<\/option>\n<option value=\"MG\">Madagascar<\/option>\n<option value=\"MW\">Malawi<\/option>\n<option value=\"MY\">Malaysia<\/option>\n<option value=\"MV\">Maldives<\/option>\n<option value=\"ML\">Mali<\/option>\n<option value=\"MT\">Malta<\/option>\n<option value=\"MH\">Marshall Islands<\/option>\n<option value=\"MQ\">Martinique<\/option>\n<option value=\"MR\">Mauritania<\/option>\n<option value=\"MU\">Mauritius<\/option>\n<option value=\"YT\">Mayotte<\/option>\n<option value=\"MX\">Mexico<\/option>\n<option value=\"FM\">Micronesia, Federated States Of<\/option>\n<option value=\"MD\">Moldova<\/option>\n<option value=\"MC\">Monaco<\/option>\n<option value=\"MN\">Mongolia<\/option>\n<option value=\"ME\">Montenegro<\/option>\n<option value=\"MS\">Montserrat<\/option>\n<option value=\"MA\">Morocco<\/option>\n<option value=\"MZ\">Mozambique<\/option>\n<option value=\"MM\">Myanmar<\/option>\n<option value=\"NA\">Namibia<\/option>\n<option value=\"NR\">Nauru<\/option>\n<option value=\"NP\">Nepal<\/option>\n<option value=\"NL\">Netherlands<\/option>\n<option value=\"AN\">Netherlands Antilles<\/option>\n<option value=\"NC\">New Caledonia<\/option>\n<option value=\"NZ\">New Zealand<\/option>\n<option value=\"NI\">Nicaragua<\/option>\n<option value=\"NE\">Niger<\/option>\n<option value=\"NG\">Nigeria<\/option>\n<option value=\"NU\">Niue<\/option>\n<option value=\"NF\">Norfolk Island<\/option>\n<option value=\"MP\">Northern Mariana Islands<\/option>\n<option value=\"NO\">Norway<\/option>\n<option value=\"OM\">Oman<\/option>\n<option value=\"PK\">Pakistan<\/option>\n<option value=\"PW\">Palau<\/option>\n<option value=\"PS\">Palestinian Territory, Occupied<\/option>\n<option value=\"PA\">Panama<\/option>\n<option value=\"PG\">Papua New Guinea<\/option>\n<option value=\"PY\">Paraguay<\/option>\n<option value=\"PE\">Peru<\/option>\n<option value=\"PH\">Philippines<\/option>\n<option value=\"PN\">Pitcairn<\/option>\n<option value=\"PL\">Poland<\/option>\n<option value=\"PT\">Portugal<\/option>\n<option value=\"PR\">Puerto Rico<\/option>\n<option value=\"QA\">Qatar<\/option>\n<option value=\"RE\">R\u00c9union<\/option>\n<option value=\"RO\">Romania<\/option>\n<option value=\"RU\">Russian Federation<\/option>\n<option value=\"RW\">Rwanda<\/option>\n<option value=\"BL\">Saint Barth\u00c9lemy<\/option>\n<option value=\"SH\">Saint Helena<\/option>\n<option value=\"KN\">Saint Kitts And Nevis<\/option>\n<option value=\"LC\">Saint Lucia<\/option>\n<option value=\"MF\">Saint Martin<\/option>\n<option value=\"PM\">Saint Pierre And Miquelon<\/option>\n<option value=\"VC\">Saint Vincent And The Grenadines<\/option>\n<option value=\"WS\">Samoa<\/option>\n<option value=\"SM\">San Marino<\/option>\n<option value=\"ST\">Sao Tome And Principe<\/option>\n<option value=\"SA\">Saudi Arabia<\/option>\n<option value=\"SN\">Senegal<\/option>\n<option value=\"RS\">Serbia<\/option>\n<option value=\"SC\">Seychelles<\/option>\n<option value=\"SL\">Sierra Leone<\/option>\n<option value=\"SG\">Singapore<\/option>\n<option value=\"SK\">Slovakia<\/option>\n<option value=\"SI\">Slovenia<\/option>\n<option value=\"SB\">Solomon Islands<\/option>\n<option value=\"SO\">Somalia<\/option>\n<option value=\"ZA\">South Africa<\/option>\n<option value=\"GS\">South Georgia And The South Sandwich Islands<\/option>\n<option value=\"ES\">Spain<\/option>\n<option value=\"LK\">Sri Lanka<\/option>\n<option value=\"SD\">Sudan<\/option>\n<option value=\"SR\">Suriname<\/option>\n<option value=\"SJ\">Svalbard And Jan Mayen<\/option>\n<option value=\"SZ\">Swaziland<\/option>\n<option value=\"SE\">Sweden<\/option>\n<option value=\"CH\">Switzerland<\/option>\n<option value=\"SY\">Syrian Arab Republic<\/option>\n<option value=\"TW\">Taiwan, Province Of China<\/option>\n<option value=\"TJ\">Tajikistan<\/option>\n<option value=\"TZ\">Tanzania, United Republic Of<\/option>\n<option value=\"TH\">Thailand<\/option>\n<option value=\"TL\">Timor-leste<\/option>\n<option value=\"TG\">Togo<\/option>\n<option value=\"TK\">Tokelau<\/option>\n<option value=\"TO\">Tonga<\/option>\n<option value=\"TT\">Trinidad And Tobago<\/option>\n<option value=\"TN\">Tunisia<\/option>\n<option value=\"TR\">Turkey<\/option>\n<option value=\"TM\">Turkmenistan<\/option>\n<option value=\"TC\">Turks And Caicos Islands<\/option>\n<option value=\"TV\">Tuvalu<\/option>\n<option value=\"UG\">Uganda<\/option>\n<option value=\"UA\">Ukraine<\/option>\n<option value=\"AE\">United Arab Emirates<\/option>\n<option value=\"GB\">United Kingdom<\/option>\n<option selected=\"selected\" value=\"US\">United States<\/option>\n<option value=\"UM\">United States Minor Outlying Islands<\/option>\n<option value=\"UY\">Uruguay<\/option>\n<option value=\"UZ\">Uzbekistan<\/option>\n<option value=\"VU\">Vanuatu<\/option>\n<option value=\"VA\">Vatican City State<\/option>\n<option value=\"VE\">Venezuela<\/option>\n<option value=\"VN\">Viet Nam<\/option>\n<option value=\"VG\">Virgin Islands, British<\/option>\n<option value=\"VI\">Virgin Islands, U.s.<\/option>\n<option value=\"WF\">Wallis And Futuna<\/option>\n<option value=\"EH\">Western Sahara<\/option>\n<option value=\"YE\">Yemen<\/option>\n<option value=\"ZM\">Zambia<\/option>\n<option value=\"ZW\">Zimbabwe<\/option>\n<\/select>\n<\/div>\n<div class=\"loc-spec-info\">\n<!--<div class=\"sys-loc-other\" style=\"display: none;\">\nPlease Specify: <input id=\"location_country_other\" name=\"location_country_other\" type=\"text\" maxlength=\"30\" size=\"30\">\n<\/div>-->\n<div class=\"sys-loc-usa\">\nSelect State:\n<select id=\"location_state\" name=\"location_state\">\n<option value=\"\"><\/option>\n<option value=\"AL\">Alabama<\/option>\n<option value=\"AK\">Alaska<\/option>\n<option value=\"AZ\">Arizona<\/option>\n<option value=\"AR\">Arkansas<\/option>\n<option value=\"CA\">California<\/option>\n<option value=\"CO\">Colorado<\/option>\n<option value=\"CT\">Connecticut<\/option>\n<option value=\"DE\">Delaware<\/option>\n<option value=\"DE\">District of Columbia<\/option>\n<option value=\"FL\">Florida<\/option>\n<option value=\"GA\">Georgia<\/option>\n<option value=\"GU\">Guam<\/option>\n<option value=\"HI\">Hawaii<\/option>\n<option value=\"ID\">Idaho<\/option>\n<option value=\"IL\">Illinois<\/option>\n<option value=\"IN\">Indiana<\/option>\n<option value=\"IA\">Iowa<\/option>\n<option value=\"KS\">Kansas<\/option>\n<option value=\"KY\">Kentucky<\/option>\n<option value=\"LA\">Louisiana<\/option>\n<option value=\"ME\">Maine<\/option>\n<option value=\"MD\">Maryland<\/option>\n<option value=\"MA\">Massachusetts<\/option>\n<option value=\"MI\">Michigan<\/option>\n<option value=\"MN\">Minnesota<\/option>\n<option value=\"MS\">Mississippi<\/option>\n<option value=\"MO\">Missouri<\/option>\n<option value=\"MT\">Montana<\/option>\n<option value=\"NE\">Nebraska<\/option>\n<option value=\"NV\">Nevada<\/option>\n<option value=\"NH\">New Hampshire<\/option>\n<option value=\"NJ\">New Jersey<\/option>\n<option value=\"NM\">New Mexico<\/option>\n<option value=\"NY\">New York<\/option>\n<option value=\"NC\">North Carolina<\/option>\n<option value=\"ND\">North Dakota<\/option>\n<option value=\"OH\">Ohio<\/option>\n<option value=\"OK\">Oklahoma<\/option>\n<option value=\"OR\">Oregon<\/option>\n<option value=\"PA\">Pennyslvania<\/option>\n<option value=\"PR\">Puerto Rico<\/option>\n<option value=\"RI\">Rhode Island<\/option>\n<option value=\"SC\">South Carolina<\/option>\n<option value=\"SD\">South Dakota<\/option>\n<option value=\"TN\">Tennessee<\/option>\n<option value=\"TX\">Texas<\/option>\n<option value=\"UT\">Utah<\/option>\n<option value=\"VT\">Vermont<\/option>\n<option value=\"VA\">Virginia<\/option>\n<option value=\"VI\">Virgin Islands<\/option>\n<option value=\"WA\">Washington<\/option>\n<option value=\"WV\">West Virginia<\/option>\n<option value=\"WI\">Wisconsin<\/option>\n<option value=\"WY\">Wyoming<\/option>\n<\/select>\n&nbsp;&nbsp;\nZip:\n<input id=\"location_zip\" name=\"location_zip\" size=\"10\" maxlength=\"10\" type=\"text\">\n<\/div>\n<\/div>\n<\/div>\n<div class=\"clear\"><\/div>\n<\/div>\n<div class=\"label-list\">\n* Have you filled out a pregnancy report form on this pregnancy already?\n<label><input name=\"prev_form\" value=\"Yes\" required=\"\" aria-required=\"true\" type=\"radio\"> Yes<\/label>\n<label><input name=\"prev_form\" value=\"No\" type=\"radio\"> No<\/label>\n<label for=\"prev_form\" class=\"error\" style=\"display: none;\"><\/label>\n<\/div>\n<div class=\"label-list\">\nPerson filling out this form?\n<label><input name=\"person_form\" value=\"Recipient\" onchange=\"toggleDiv('.person-details', true)\" type=\"radio\"> Recipient<\/label>\n<label><input name=\"person_form\" value=\"Doctor_Staff\" onchange=\"toggleDiv('.person-details', false)\" type=\"radio\"> Doctor&#8217;s Office Staff<\/label>\n<div class=\"person-details\" style=\"display: none;\">\n<div>\nHave you given birth to other children by this donor?\n<label><input id=\"birth_same_yes\" name=\"birth_same\" value=\"Yes\" onchange=\"toggleDiv('.sys-person-1', true)\" type=\"radio\">Yes<\/label>\n<label><input id=\"birth_same_no\" name=\"birth_same\" value=\"No\" onchange=\"toggleDiv('.sys-person-1', false)\" checked=\"\" type=\"radio\">No<\/label>\n<\/div>\n<div>\nIs there a partner who also has children by the same donor?\n<label><input id=\"partner_same_yes\" name=\"partner_same\" value=\"Yes\" onchange=\"toggleDiv('.sys-person-2', true)\" type=\"radio\"> Yes<\/label>\n<label><input id=\"partner_same_no\" name=\"partner_same\" value=\"No\" onchange=\"toggleDiv('.sys-person-2', false)\" checked=\"\" type=\"radio\"> No<\/label>\n<div class=\"sys-person-2\" style=\"display: none;\">\nPlease provide name of partner <input name=\"partner_name\" maxlength=\"50\" type=\"text\">\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div>\n<p>Please enter your email address. We will contact you only if we have questions about the data you have submitted.<\/p>\n<p>* Email: <input id=\"email\" name=\"email\" maxlength=\"50\" type=\"text\"><\/p>\n<br>\n<div class=\"button-cnt\">\n<div class=\"g-recaptcha\" data-sitekey=\"6LetRUYUAAAAAC5xmo9ggW172bol8J69esyjm-7y\">&nbsp;<\/div>\n<div id=\"pregnancy-report-form-error\" style=\"display: none;color:red\"><br>\n<p>Unexpected Error! Please call Client Services at 800-338-8407 or email us at info@fairfaxcryobank.com for assistance in making this pregnancy report.<\/p>\n<\/div>\n<input value=\"Submit\" type=\"submit\">\n<\/div>\n<div class=\"submit-progress\"><\/div>\n<\/div>\n<\/div>\n<\/form>\n<script type=\"text\/javascript\" src=\"\/search\/js\/jquery\/jquery-ui-1.10.3.custom.min.js\"><\/script>\n<script type=\"text\/javascript\" src=\"\/search\/js\/jquery\/jquery.validate.min.js\"><\/script>\n<script type=\"text\/javascript\" src=\"\/search\/js\/cryobank\/pregnancyreport.js\"><\/script>\n<script src=\"https:\/\/www.google.com\/recaptcha\/api.js\"><\/script>\n<\/div>\n\n\n\n<p>If you have any questions about your pregnancy report, email Fairfax Cryobank&#8217;s Client Services team.<\/p>\n\n\n\n<div class=\"wp-block-button aligncenter\"><a class=\"wp-block-button__link has-background\" href=\"mailto:info@fairfaxcryobank.com\" style=\"background-color:#ea6950\">Contact Client Services<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Congratulations! We appreciate you reporting your pregnancy to Fairfax Cryobank! Thank you for taking the time to complete this form to report your pregnancy using a Fairfax Cryobank donor. This helps us keep our records up-to-date for future Fairfax Families.&nbsp; Please do not report a pregnancy with this online form &#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-27472","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>\u598a\u5a20\u62a5\u544a | Fairfax Cryobank<\/title>\n<meta name=\"description\" content=\"Thank you for taking the time to report your pregnancy to Fairfax Cryobank! 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