Pregnancy Report Form - SellmerDiers
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Thank you for taking your time to complete this form about your pregnancy.

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 in the (unlike) event of your pregnancy being terminated without a live-born child (missed abortion, stillbirth 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 for each clinical pregnancy.

  • INFORMATION ABOUT THE PERSON FILLING OUT THIS FORM

  • INFORMATION ABOUT THE ORDER AND THE DONOR

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

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

My brother and his wife had troubles conceiving. This caused us to talk about the topic in general, and it made me realise that I wanted to help other people, who are in the same situation as them. Quote by Stuart
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