Pregnancy Report Form

Congratulations on your pregnancy! Thank you for taking the time to complete this form to report your pregnancy using a Fairfax Cryobank donor.  

If you used an ID Option donor, you will also need to complete the ID Option Birth Registration form to allow your child to have the option to obtain donor information on or after their 18th birthday. For a pregnancy by an ID Option 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.

See our Policy on Limiting Donor Births to see when donors are stopped.

* Indicates required field

* Order No.
(Obtained at time order placed. Call us or click to chat if you need this information.)


 * Donor No.


Preparation Type  ICI  IUI  IVF 


* Pregnancy

Biochemical (Positive pregnancy test)
Clinical (Positive pregnancy test AND sonogram showing a fetal heartbeat)


* Location where insemination took place


* Have you filled out a pregnancy report form on this pregnancy already?
Yes  No


Person filling out this form? Patient  Doctor's Office Staff


Please enter your email address. We will contact you only if we have questions

about the data you have submitted.

* Email: