Clinic forms

These forms are for clinic staff. The relevant form should be printed out, completed and submitted to us (eg, person responsible entry programme; initial licence enquiry form, mitochondrial donation forms).

 

Initial licence enquiry

This form is for clinics to register their interest in applying for a licence to carry out fertility treatment and register their person responsible.

Person responsible entry programme

An individual can only be appointed as a clinic’s person responsible (PR) if they have our approval. That person must complete the person responsible entry programme (PREP) assessment before we can consider whether or not to approve them. There are two different PR entry programmes depending on whether you wish to be the PR of a treatment and storage centre or a research project:


PREP treatment and storage: Please email HFEACompliance@hfea.gov.uk to be sent login details that will enable you to access the test or if you have any additional questions.

Mitochondrial donation forms

Clinics should use these forms to apply for authorisation to carry out mitochondrial donation.

Donor information form

A Donor information form must be completed for all sperm or egg donors including surrogacy commissioning couples and those registered separately as a patients.

If the donor has taken up the option of adding a goodwill message for any children born as a result of their donation they can do so on pages 3 and 4 of this form.

The information contained on pages 1 and 2 of this form should be submitted to the HFEA via EDI before images of the rest of the form (handwritten pages 3 and 4) are scanned into the register via PRISM.

You can also print this form (including pages 3 and 4) from your EDI application.

Donor re-registration form

This form should be used if you have a donor who donated before April 2005 as an anonymous donor and would like to re-register to become identifiable.

The B form records the contact details for the donor and must be signed by the donor. You should verify the identity of the donor and submit copies of this document.

The form should also be sent to the HFEA for submission into the Register which enables us to flag the donor as identifiable.

Donor insemination

Early outcome

Patient and partner registration

Pregnancy outcome

Intention to treat

Welfare of child

Medical Practitioner’s Statement – only to be used under the 2024 Regulations

This form must only be used under specific circumstances as set out in section 11 of the Clinic Practical Guide on legal changes to storage limits and guidance.