Application for semen for patients

Complete the form below to start the application process and facilitate the procurement of semen that meets your specific medical needs.

Date of request:

Date of treatment:

Treatment selection (R.A. Technique)*

Information concerning the applicant

Date of birth:

Height

Weight

Sanguine Group

Ethnicity

Aspect

Hair colour

Texture

Skin

Eyes

Without a partnerWith male partnerWith female partner

Partner information

Date of birth:

Height*

Weight*

Sanguineo Group*

RH*

Ethnicity*

Aspect*

Hair color*

Texture*

Skin*

Eyes*

Partner information

Date of birth:

Height*

Weight*

Sanguine Group*

RH*

Ethnicity*

Aspect*

Hair color*

Texture*

Skin*

Eyes*

I would like confirmation via*

I have ordered more times*

Children born from our bank

I would like to receive information on new treatments and news from Clinica Tambre.

I have read and accept the privacy policy

Together with this request for banked semen, the receiving centre will be responsible for carrying out and reporting the obstetric follow-up of each pregnancy for the control of the pregnancies of the Mistral Fertility Center Sperm Bank in accordance with the provisions of LAW 14/2006, of 26 May, on assisted human reproduction techniques.

The amount must be paid by bank transfer to the account number ES35 0081 5243 42 0001860087 (Sabadell) in the name of Mistral Fertility Clinics, S.L. indicating your full name. You must also send the bank receipt, at least two days in advance, to the following e-mail address: administracion@clinicatambre.com

Read Personal Data Protection

In accordance with the provisions of Organic Law 3/2018 on Personal Data Protection and guarantee of digital rights and Regulation (EU) 2016/679, we inform you that your personal data will be processed and stored in files under the responsibility of Clinica Tambre (Mistral Fertility Clinics, S.L.), for the purpose of managing the medical provision of the service requested, as previously indicated in the event of a positive response. We also inform you that Clinica Tambre works with external laboratories, which is why the patient expressly consents to the transfer of their data for the sole and essential purposes related to the purpose of the aforementioned laboratories. If this data is not provided, it will not be possible to provide the healthcare service. In any case, you may exercise your rights of access, rectification, cancellation and opposition by contacting the centre’s headquarters at C/ Tambre, 8 28002 – Madrid.