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| Place of Specimen Collection |
: |
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| Time of Collection |
: |
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| Time of Examination |
: |
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GROSS
EXAMINATION |
| Liquefaction Time |
: |
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| Colour |
: |
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| Volume of Semen |
: |
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| Viscosity |
: |
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| PH |
: |
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MICROSCOPY |
| Sperm Count |
: |
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| Total Sperm Count |
: |
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| Motility (%) |
: |
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| Rapid & Linear Progressive
Motility |
: |
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| Slow & Sluggish Non-Linear |
: |
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| Remarks |
: |
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| Head Forms |
: |
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| Body Forms |
: |
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| Tail Forms |
: |
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| Immature Cells |
: |
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| Pus Cells |
: |
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CHEMICAL
EXAMINATION |
| Auto agglutination |
: |
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| Fructose |
: |
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| Interpretation |
: |
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