Report Your Pregnancy Outcome

  • Phone:   510.841.1858
  • Fax:        510.841.0332
  • Email:    click here

We maintain complete records of pregnancy outcomes that include not only births, but also miscarriages, stillbirths, and therapeutic abortions. This helps us maintain a donor's family limit, track health and medical information for donors, recipients, and children, and provide ongoing services to families after children are born.

This report concerns your most recent pregnancy with TSBC samples. If you are unsure about a question or prefer not to answer, just leave it blank or enter 'unsure' / 'withheld' and a Healthworker will follow-up with you. We guarantee complete confidentiality. No identifying information will be released. If you prefer to mail or fax the form, click here for a pdf version or simply fill out the form below, print it, and fax or mail it in. Thank you for your time.

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Report the Outcome of Your Pregnancy

Section 1
Section 2
Have you moved?
Section 3
Pregnancy Outcome:
Live birth
Pregnancy loss
Additional Questions
Delivery issues
Section 4
Child #1
Weight
Length
Child #2
Weight
Length
Child #3
Weight
Length
Section 5

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