{"id":2207,"date":"2019-09-05T18:22:12","date_gmt":"2019-09-05T18:22:12","guid":{"rendered":"https:\/\/fairfaxcryobank.com\/?page_id=2207"},"modified":"2020-08-28T10:08:58","modified_gmt":"2020-08-28T14:08:58","slug":"pregnancy-report-form","status":"publish","type":"page","link":"https:\/\/fairfaxcryobank.com\/uk\/pregnancy-report-form","title":{"rendered":"Pregnancy Report Form"},"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 ID 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 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 0800-404-9186 to assist you.<\/p>\n<p>See our <a class=\"blue1 a3\" href=\"\/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 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<p><script type=\"text\/javascript\" src=\"\/search\/js\/jquery\/jquery-ui-1.10.3.custom.min.js\"><\/script><br><script type=\"text\/javascript\" src=\"\/search\/js\/jquery\/jquery.validate.min.js\"><\/script><br><script type=\"text\/javascript\" src=\"\/search\/js\/cryobank\/pregnancyreport.js\"><\/script><script src=\"https:\/\/www.google.com\/recaptcha\/api.js\"><\/script><\/p>\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:global@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-2207","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>Pregnancy Report Form | 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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