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Theraputic Donor Insemination (TDI) Client and Physician Forms


Forms

We only ship specimens directly to a physician's office. We do not ship specimens to a patient's home. Prior to ordering specimens for the first time, patients must sign a TDI Client Purchase Agreement (link below) and return the original signed document by mail prior to placing an order for donor specimens.

Theraputic Donor Insemination (TDI) Client Purchase Agreement

If we have not previously shipped specimens to your physician's office, we need to have the physician sign a Physician Purchase Agreement and complete a New TDI Account Information Sheet (links below).

Physician Purchase Agreement
New Theraputic Donor Insemination (TDI) Account Information Form

Note: The physician's documents must be returned via fax or mail prior to the date the specimens are to be shipped.

International Cryogenics, Inc.
32121 Woodward Ave. Suite 205, Royal Oak, MI 48073
Phone - 248-397-8449
Fax - 248-397-8392
Email - iciinfo@sbcglobal.net

  • Note: If the forms will not open from your browser or desktop, you may need to download Adobe Reader. You can do this by clicking on the Adobe Reader box below right.

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