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Informed Consent For Donor 18043 Giordano

("Patient to be inseminated") hereby acknowledge and represent as follows:

	The undersigned patient seeks to use donated semen from Donor 18043 (Giordano) collected by the Seattle Sperm Bank for reproductive use.
	Patient understands that donor has tested positive as a carrier of Dystrophic Epidermolysis Bullosa. .
	Patient is aware of the aforementioned exceptions and genetic disease risks associated with each.
	Patient agrees to personally assume all risks associated with Patient’s use of semen samples donated by a Donor that has tested positive as a carrier of Dystrophic Epidermolysis Bullosa. Patient hereby releases Seattle Sperm Bank and its current and former officers, directors, employees, attorneys, insurers, agents and representatives of any liability or responsibility whatsoever for any and all outcomes, whether currently known, suspected, unknown or unsuspected, arising out of Patient’s use of donor semen donated by Donor that has tested positive as a carrier of Dystrophic Epidermolysis Bullosa.

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I DECLINE Testing	I understand the risks associated with using donor semen donated by Donor 18043 (Giordano) that has tested positive as a carrier of Dystrophic Epidermolysis Bullosa, and I have been offered genetic testing for this condition by Seattle Sperm Bank and I am choosing to DECLINE testing on myself for this condition.
I ACCEPT Testing	I understand the risks associated with using donor semen donated by Donor 18043 (Giordano) that has tested positive as a carrier of Dystrophic Epidermolysis Bullosa, and I have been offered genetic testing for this condition and have chosen to have myself screened for this condition, as facilitated by Seattle Sperm Bank through the use of genetic testing.

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Signed by Seattle Sperm Bank
Signed On: November 11, 2024

Timestamp

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October 23, 2024 7:47 am PST

Informed Consent For Donor 18043 Giordano Uploaded by Seattle Sperm Bank - [email protected] IP 50.175.77.114