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T: 204.779.8888 F: 204.779.8877 701-1661 Portage Ave. Winnipeg, MB R3J 3T7 Alternate Contact / Responsible Party Form For Gamete Cryopreservation Consent I, agree to be an alternate contact and to
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How to fill out gamete cryo alternate contact:

01
Obtain the gamete cryo alternate contact form from the relevant authority or fertility clinic.
02
Fill in your personal information, including your full name, date of birth, and contact details. Ensure that your contact details are accurate and up to date.
03
Provide the contact information for your designated alternate contact, who will be responsible for making decisions regarding the use or disposal of your stored gametes in case you are unable to do so.
04
Specify the relationship between you and the alternate contact. This could be a spouse, partner, family member, or close friend.
05
Indicate whether the alternate contact has been previously informed about their potential role and agrees to assume responsibility if necessary.
06
Review the form for any errors or omissions before submitting it.
07
If required, sign and date the form to validate your agreement with the provided information.

Who needs gamete cryo alternate contact?

01
Individuals or couples who are undergoing fertility treatments, such as IVF, and have chosen to store their gametes (sperm or eggs) for future use.
02
People with medical conditions or undergoing treatments that may affect their fertility, such as cancer patients undergoing chemotherapy or individuals planning gender-affirming procedures.
03
Those who want to ensure that someone they trust can make decisions regarding the use or disposal of their stored gametes in the event of incapacitation or death.
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Gamete cryo alternate contact is the contact information provided for alternate individuals to be contacted in case of emergency or other unforeseen circumstances related to cryopreserved gametes.
Individuals who have cryopreserved gametes are required to file gamete cryo alternate contact.
Gamete cryo alternate contact can typically be filled out through a form provided by the facility where the gametes are stored, and should include contact information for designated individuals.
The purpose of gamete cryo alternate contact is to ensure that there are appropriate individuals who can be contacted in case of emergencies or other situations related to cryopreserved gametes.
Information such as names, phone numbers, and relationships to the individual storing the gametes must be reported on gamete cryo alternate contact.
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Cryopreservation Cryopreserved 2013 R3J 3T7 Cryo Gamete Portage MB Gynecology Winnipeg Heartland revised Ave Fertility

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