Fertility Answers - Helping Build Families

Fertility Answers Media Consent

Please sign the following media release when submitting media (photographs, images, videos, testimonials, letters, birth announcements) to Fertility Answers. Please identify the “subject” of the media, that is who can be identified in the media, and their date of birth. When finished completing the form and signing, please press Submit so we can save the release to your Fertility Answers patient file.


Fertility Answers Media Release

Patient Name(Required)
Patient Date of Birth(Required)
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    Subject Birthdate(Required)
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    Date Signed(Required)