CNY Fertility Center - Baby Story Submission

Baby Story Submission

CNY Fertility Center counts our successes on tiny fingers and toes! We have helped thousands of couples become parents since 1997.

Are you a previous patient of CNY Fertility Center who would like to share your story of becoming a mom or dad after infertility treatments or adoption? Now you have the option to share your story, upload a picture of your little miracle(s) and share your successes with our CNY Fertility Center Family. We are looking to feature previous patient’s stories online, in our e-newsletters and in future publications. You can choose to have your child’s image featured on our digital picture frames in our offices, online in our success stories album and in our special e-newsletter sections celebrating their arrival. Simply follow the instructions below to submit your story!

Fields marked with an asterisk * are required.


Parent Information
	**Please provide parents' names. If you're uploading a photo, you will need to browse for it again.
* Name of parents: (only first names will be shared)
	**Please insure that you've provided valid matching email addresses. If you're uploading a photo, you will need to browse for it again.
* Email address:
* Confirm email address:

Baby Information
	**Please provide baby name and birth date. If you're uploading a photo, you will need to browse for it again.
* Baby #1 name:	* Baby's birth date:
Baby #2 name:	* Baby's birth date:
Baby #3 name:	* Baby's birth date:
	**Please type your baby story in the box below. If you're uploading a photo, you will need to browse for it again.
* Share your baby story: (your story will be shared as written)
	**There was a problem uploading your photo. Please browse for your photo again.
Upload baby photo:

Authorization (Please select one option)
	**Please type your initials into one of the authorization boxes. If you're uploading a photo, you will need to browse for it again.
	Please initial here to confirm that you authorize CNY Fertility Center and any of its entities, subsidiaries or employees to use the information and pictures you have submitted with this form, for but not limited to, our website, office digital picture frames, success stories emails to patients, success story e-blasts, or for future printed promotions. Your last name will NOT be used unless we receive an additional release from you. Your email address and contact information will not be sold or used outside of CNY Fertility Center’s entities. I understand that CNY Fertility Center and its entities will use my email address to contact me regarding CNY Fertility Center upcoming events, with e-newsletters and for promotions of the company. I do not hold CNY Fertility Center or entities liable for any negative outcome that could occur as a result of my authorization for their use of photos, names, stories etc.

	Please ONLY share my story, pictures or name with CNY Fertility Center Employees.