Financial Disclosure

I, the “Patient”, have chosen to purchase a Fellow Health, Inc. (“Fellow”) Full Semen Analysis Test Kit or Vasectomy Test Kit through my Clinic. I understand that the testing laboratory will be Fellow Health, Inc., 1933 Davis Street, San Leandro, CA 94577.

I understand that my Clinic has a financial arrangement with Fellow whereby my Clinic provides administrative services and stores the Test Kits for Fellow for a services fee.

I further understand that I have the right to choose my service provider, including Fellow, an alternative provider, or local labs.

If I choose to have services performed at an alternative facility, I understand that my Clinic will not treat me differently.

I acknowledge that I have been fully informed of my Clinic’s financial arrangement with Fellow.

LAST MODIFIED: 11/29/2025