888-CORDUSE

Enrollment Step 1 of 3: Contact Information

Name of Expectant Mother*

Father's / Partner's Full Legal Name

Expected Due Date:*

How Many Newborns Are Expected


How Did You Hear About CORD:USE?*


Are You a Returning CORD:USE Client


Were You Referred by a CORD:USE Client*


You may complete your enrollment now by clicking continue for agreement review and payment. You may then complete below information later when you receive your kit or you may provide it now.








Additional Information



Type of Birth
(Check Any That Apply)



Scheduled Cesarean

Induction

Adoption

Surrogate

Natural

Mother's Date of Birth

Father's / Partner's Date of Birth

Type of ID

Populate with Father's / Partner's info

Emergency Contact's





If you have any problems enrolling, please call 1.888.CORDUSE (267.3873), and one of our cord blood specialists will enroll you over the phone.


Additional important information can be found within the Terms of Use and Privacy Policy

Privacy is very important to us. Therefore, we will not provide any information about you to a third party unless specified in the Client Service Agreement or Informed Consent or required by law. Upon completion of the on-line enrollment, your information will be encrypted and protected.


Cord Blood Saves Lives.

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