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Semen Analysis Requisition - Alberta Health Services

Semen Analysis RequisitionTest Request For testing locations and important information, see Side B (back of Requisition ) Fertility Screen By appointment only, see Side BEdmonton Only Fertility Assessment Retrograde Analysis (refer to patient information / preparation sheet provided by physician) Sperm AntibodyAll above tests by appointment only, see Side B Post-Vasectomy Appointment may be required, see Side BCollection RequirementsCollection of Semen Post Vasectomy specimen should be collected 3 months after vasectomy. Abstain/Do not ejaculate for a minimum of 2 days and a maximum of 7 days. Collect entire specimen directly into the container provided.

Report any loss of specimen. • DO NOT collect in a condom or use lubricants Specimen labeling • Label container with Patient Name, Personal Health Number and Date/Time of collection. • Ensure the information on this requisition is complete.

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