A trusted resource for women planning alternative families

Begin Your Registration Now!
(Southern CA Area Clients)

Everything you need to register to begin your insemination process is included in this easy-to-use kit. When you’ve completed the forms included, please mail or fax (if faxing, please also mail the original) to:

Registration Coordinator, Pacific Reproductive Services
65 North Madison Street, Suite 610
Pasadena, CA 91101
Fax: (626) 432-6869		 NOTE: If you
are NOT from the Southern California area, please click here. Forms are slightly different.

 

Download Registration Kit - for Southern CA Clients

Please review our Information and Registration packet by clicking on the items below. This packet contains information to help you begin the insemination process, and the forms you need to register. Be sure to read item 1: “How to Register - Recipient Information for Ordering and Use of Donor Specimens”. It tells you everything you need to know about how to get started. It is important that you become familiar with Pacific Reproductive Services’ policies and processes before purchasing sperm.

  2. Recipient Registration Form *
  3. Agreement for Administration of Donor Sperm*
  4. Medical Certification Form *
  5. Notice of Privacy Practices (HIPAA)
  6. Notice of Privacy Practices Summary *
  7. Donor Catalog
  8. Product and Service Fees
  9. Suggested Reading and Alternative Resources
  10. Basal Body Temperature Charts and Instructions
  11. For Recipients Using Private (Directed) Donors
  12. NEW - Specimen Order Form *

* Complete form & return to: PRS-SoCal, ATTN: Registration & Account Set-up, 65 N. Madison Ave. Suite 610, Pasadena, CA 91101

If you cannot print out this information, you can also request a Registration Info Packet be sent to you:

  1. Call PRS-SoCal: 1-626-432-1681, leave your name & address, we’ll US Postal mail it; OR
  2. Fax PRS-SoCal: 1-626-432-6869, send us your name and address, we’ll US Postal mail it; OR
  3. Email us: [email protected], we’ll email you back the Info packet.

The Staff at Pacific Reproductive Services wants to extend a warm welcome to you. We want you to know that we are here to support you and provide whatever assistance you may need to begin building your family. Please don’t hesitate to call, email or fax if you need more information or help.


Download Adobe Acrobat Reader Here! NOTE: To download our Acrobat (.PDF) files, you'll need Adobe Acrobat Reader installed on your system. If you don't have it installed, please do so (for free!) by clicking on the logo at right.