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Thank you for taking your time to complete this form about the outcome of your treatment.

We guarantee complete confidentiality. No identifying information will be released. This report will only be used to record children born from a particular donor, and to track for the purpose of birth limits.

Please return to this form again and keep us updated about any outcome of your treatment and pregnancy. Please report the following:

  • Pregnancy,
  • A negative result of a treatment
  • If the pregnancy is terminated (missed abortion, stillbirth etc.)
  • Birth
  • Birth of twins, triplets etc.

If you have any questions or need help to fill in the form, please don’t hesitate to call us at +45 20 55 65 95 or send an e-mail to salg@sellmerdiers.dk

Please provide the following information:

Pregnancy Slot Report Form

  • INFORMATION ABOUT THE PERSON FILLING OUT THIS FORM

  • INFORMATION ABOUT THE ORDER AND THE DONOR

  • Obtained from SellmerDiers when the order was placed
  • Starts with DK26 (40 characters)
  • INFORMATION ABOUT THE FERTILITY TREATMENT

  • Date Format: MM slash DD slash YYYY
  • INFORMATION ABOUT THE RECIPIENT

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