MicroSort^® Forms

The forms listed below and are available for viewing and printing. The documents are in PDF format and are automatically viewed in Acrobat Reader.  (If you do not have Acrobat Reader on your computer, you may download a free copy here.)  Copies of these forms are also available by contacting the MicroSort office at  800-277-6607.

Important: All forms must be completed in black ink. No modifications of the form are acceptable. All forms requesting a Witness, must be signed by a witness 18 years or older.

Registration Form
Medical History Form
Informed Consent for Participation in MicroSort - Fairfax location
Informed Consent for Participation in MicroSort - Laguna Hills location
Medical Record Release: ART Procedure
Medical Record Release: Prenatal
Medical Record Release: Birth
Medical Records Release: Pediatrics
Notification of Payment Method
HIPAA Research Authorization - MUST be completed by ALL participants

Additional Forms required for IUI (Intrauterine Insemination) Patients:

These instruction sheets are meant to be a general guide and contain items that may or may not necessarily apply to a particular participant:

Informed Consent to Test for HIV - Individual forms required for both husband and wife, Not valid without witness signature
Informed Consent for Use of Husband's Semen in Artificial Insemination - Not valid without witness signature
HCG Injection Instructions

Important Information for the MicroSort® IUI Participant
Checklist for the MicroSort® IUI Participant
How to Fill Out Your MicroSort® Consents Correctly
MicroSort® IUI Instructions for the Husband
How to Use Your Ovulation Predictor Kit (OPK) for MicroSort® IUI Participants
Instructions for After Your MicroSort® IUI

Additional Forms required for IVF/ICSI (In Vitro Fertilization ) Patients:

Storage and Semen Destruction Form