Medium

Available on

Apple Android Windows

Midwife Sperm Sample Consent Mobile App

Intracervical Insemination (ICI) and Intrauterine Insemination (IUI) involve the placement of sperm or semen into the cervix or uterus for the purpose of becoming pregnant. We strongly encourage a thorough understanding of the risks and benefits to any given insemination sample, the STI-status of the sample to be used in insemination and advance planning for any legal issues that may arise with known donor samples. Use the Midwife Sperm Sample Consent mobile app with a smartphone or tablet to allow patients to read and consent to intracervical insemination (ICI) and intrauterine insemination (IUI)

GoCanvas has a collection of apps developed for Midwives and Doulas. They are all Free with your GoCanvas Subscription. Check them out in our Application Store!

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Midwife Sperm Sample Consent Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Intracervical Insemination (ICI) and Intrauterine Insemination (IUI) involve the placement of spe...

  • Ico statictext

    I agree to provide either fresh semen or IUI-ready sperm samples, which I will bring with me to m...

  • Ico statictext

    I understand that <Insert Name> does not quantify sperm count or motility, provides no estimation...

  • Ico statictext

    I forever release and absolve <Insert Name>, and any of its staff and board members, from any and...

  • Ico textbox

    Client Name

  • Ico signature

    Signature

  • Ico date

    Date

  • Ico textbox

    CNM/RN Name

  • Ico textbox

    Signature

  • Ico date

    Date

  • ...and More!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

Midwife PDR Consent

This Midwife PDR Consent Mobile App allows midwives and birthing centers to collect and share medical health data with the...

App Name

Midwife Erythromycin Ophthalm Ointmen...

Antibiotic eye ointment is routinely given to newborns in the hospital. It is given to prevent eye infections that could ...

App Name

Midwife ICI Consent

Intracervical Insemination (ICI) is the placement of semen onto the cervix for the purpose of becoming pregnant. The plac...

App Name

Midwife Medicaid Consent

If your patient currently has Medicaid coverage, you will want to make them aware of your contract status and the requirem...

App Name

Newborn Transport Form

If you work on a newborn transport team or hospital transport services, you may find it useful to try the Newborn Transpor...

App Name

Birth Doula Data Collection Form

Please have Doulas answer all applicable items in each category provided in the Birth Doula Data Collection Form mobile a...

App Name

Midwife General Statement and Pregnan...

The Midwife General Statement and Pregnancy Care Agreement mobile app is designed for midwives that offer an alternative...

App Name

Midwife HIPAA Privacy Statement

This notice describes how medical information about you may be used and disclosed and how you can get access to this infor...

More Information