We maintain records of all 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, including alerts when medical issues arise. 

This report concerns a pregnancy loss with TSBC samples. If you are unsure about a question, leave it blank. We guarantee complete confidentiality. No identifying information is 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.