Additional Information

Thank you for entrusting your specimen to the Men’s Fertility Laboratory and NY Cryo! Just a few more steps to complete.

If you have requested an appointment for Testis Tissue Processing please complete the additional information below. Our staff will be in touch with you shortly.
If you have scheduled an appointment for a Laboratory Service please complete the additional information below. You will also shortly receive an electronic form (DocuSign) to complete. This can be easily done on your smartphone, tablet, or computer. Please don’t print the form out to complete. We have gone paperless! If you don’t receive it within the hour please call us at 516-487-2700 or email us at FrontDesk@nycryo.com.
1. Please read the Procedure for Semen Specimen Collection prior to your giving a specimen. A properly collected specimen is essential.
2. Please upload (see button below), email (FrontDesk@NYCryo.com), or Fax (516-487-2007) your Prescription for the test and your photo ID. As an alternative, you can take a picture of them with your phone and send them to us.

PLEASE NOTE: We are required to have a Prescription submitted and a Specimen Production Form completed before we can accept your specimen. The Specimen Production Form is part of the DocuSign documents you will receive. If you are producing the specimen at home please complete this form prior to dropping the specimen off at our office. If you are producing the specimen at our office you will complete it at our office.

If you have your Healthcare provider's prescription for the test please upload it here. You can also Fax it to us at 516-487-2007 or email it to us at frontdesk@nycryo.com. We cannot perform the test and/or report results without a prescription from a licensed healthcare provider. If you do not have one please call our office before producing the specimen and speak with our staff at 516-487-2700.
Drop files here or

Max. file size: 512 MB.
Patient Name*
First Last
Patient Date of Birth*
MM slash DD slash YYYY
Patient Phone
Patient Email*
Last four digits of patient's Social Security Number*

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If you have any questions please call us at 516-487-2700.

Additional Information

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