Sch 1Consent to carrying out a treatment procedure

Schedule 1—Consent to carrying out a treatment procedure

Regulation 6

Part A—Consent of woman who will undergo treatment procedure

I, [name of woman who will undergo treatment procedure]
of [address] consent to the following treatment procedure being carried out on me—

🞏 artificial insemination;

🞏 assisted reproductive treatment.

*Part B—Consent of partner of woman who will undergo treatment procedure

I, [name of partner of woman who will undergo treatment procedure]
of [address] consent to the following treatment procedure being carried out on [name of woman who will undergo treatment procedure]—

🞏 artificial insemination;

🞏 assisted reproductive treatment.

1. PART B must be completed if the woman consenting to the treatment procedure has a partner as defined in section 3 of the Act.

partner, in relation to a person, means—

(a) the person's spouse (other than a spouse from whom the person has separated); or

(b) a person who lives with the first person as a couple on a genuine domestic basis, irrespective of gender.

2. Section 20A of the Act provides that if gametes produced by the partner of a woman are to be used in a treatment procedure carried out on the woman, the consent of the woman and her partner to the treatment procedure is taken to be withdrawn on their separation. If you and your partner separate in these circumstances, as soon as practicable after separation you are each required to give written notice of the separation in the form prescribed in Schedule 2A, to either—

(a) the registered ART provider or doctor to whom the original consent was provided; or

(b) the registered ART provider or doctor with whom the sperm, oocyte or embryo to which the consent relates is kept or stored.

2A. If you and your partner separate in circumstances other than those outlined in note 2 above, you or your partner are asked to please notify the registered ART provider or doctor carrying out the treatment procedure that you have separated. However, any withdrawal of consent must be provided to the ART provider or doctor separately and in accordance with note 3 below.

3. Consent may be withdrawn at any time before the treatment procedure or action consented to is carried out using the following procedure—

(a) the withdrawal of consent must be in writing;