LGBT
*Please follow the instructions sheet for sample collection *Fill out and print before submitting the upper portion of this form and hand it to the receptionist together with your semen sample cup *MAKE SURE THAT THE SPECIMEN CUP IS LABELED WITH YOUR NAME *Required Field
Payment is due at the time of service. If you wish to know the fee for any service in advance of scheduling, please feel free to ask the receptionist. By signing in the box below you agree to accept the terms of our fees policies
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