Semen Analysis: Patient Information
Instructions

  1. Semen analyses are performed Monday through Friday, 8:30 AM to 4:00 PM at Associates in Urology office suite at the address below, and must scheduled in advance.
  2. Clean containers are required for collection of semen and can be obtained from our office from your private physician.
  3. The patient must abstain from ejaculation for two to five days prior to collection of the sample. Longer abstinence may impair the semen quality. The sample may be caught in the container to give accurate results. Regular condoms cannot be used as they contain a spermacide.
  4. Payment is due at the time services are rendered.
  5. Patients will be asked to fill out information (on the bottom half of this page) to hand in with the specimen. In addition, the patient must label the specimen container with his name.
  6. The specimen must be kept at body temperature. Do not heat or refrigerate the sample. If collected outside the office, the sample may be transported in a pocket to keep it at body temperature.
  7. Copies of the analysis are available upon request. Routinely, however, tests results require appointment with Dr. Seaman for a detailed interpretation and treatment plan.
  8. Specimens must arrive within 1 hour of being produced.
  9. Please note: your office visit may be arranged the same day of semen analysis; however, as the specimen remains in the incubator for 20 minutes prior to analysis, the results will not be available until at least 50 minutes after the specimen is received.
  10. Please note: A semen analysis is primarily a test of fertility. Therefore a fertility related diagnosis and/or procedure code will be used if coverage is submitted to your insurance company.

Patient Information


__________________________
Name


______________________
Date


__________________________
Time of Collection


__________________________
Social Security Number


__________________________
Number of Day of Abstinence

__________________________
Time Specimen Received
(to be filled in by receptionist)

Eric K. Seaman, MD Male Reproductive Medicine and Surgery, Associates in Urology
741 Northfield Avenue, Suite 206; W. Orange, NJ 07051 (973) 325-6100 Fax: (973) 325-1616