DocuSign Form for OverNite Male

To order a kit, please start the DocuSign Form below.

PLEASE NOTE: Your form must be completed and submitted, and payment made, prior to the shipment of the kit. Pay for the kit by entering your credit card number in the secure DocuSign form. Alternatively, you can contact us for a PayPal payment link. For next-day delivery, your order must be completed by 1 PM Central Time, Monday – Thursday.

2024 UIC Holiday Closures:
Thanksgiving Holiday – Thursday & Friday, Nov. 28-29

The OverNite Male kit is only available to U.S. residents in the 50 states. We do not offer this service to Puerto Rico and other U.S. territories.

Residents of Hawaii should call ReproTech to determine if a kit can be ordered for you. You may also contact our partner clinic in Honolulu, HI, Fertility Institute of Hawaii, for in-person sperm freezing services.

If you have been approved for a discounted kit through Livestrong Fertility, please contact us to confirm we have received your approval.

Call or email us with questions: 651-489-0827 or infomn@reprotech.com between the hours of 8:00 AM and 5:00 PM Central Time M-F.

Client Information

NOTE: Plan up to 10 minutes to complete your form.

Required Information For Signing

Email Address:
- Your email will be used for important account correspondence.
- Personal Health Information will be delivered to this address including a copy of your DocuSign contract(s).

Payment Method:
- Your credit/debit card or E-Check information for payment verification

Are the specimens being stored for a minor* patient?
[*Minor is defined as younger than 18 for all US states except AL (19), NE (19) & MS (21)]

Yes No

Client A

First Name

Middle Name Or Preferred Name

Last Name

First Name

Middle Name

Last Name

Clinic:

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