Download Info Pack
Pricing
Pricing

Web Enrolment

Please choose a plan
Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Required field

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input


Invalid Input
Invalid Input

Invalid Input

Invalid Input
Invalid Input

Invalid Input

Health History Questionnaire



All information herein will be kept strictly confidential, save for declaration required by law and/or for transplant purposes. We request your kind understanding that sensitive questions are asked to help us make the cord blood collection process and subsequent use safe.


All "Yes" answers require an explanation. Please use the textbox allocated at the end of each question.

Invalid Input
Invalid Input
Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input

12. In the past 5 years, have you:

Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Travel History
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Genetic/ Family History
Has your baby’s biological father, his family members or any of your family members (biological parents and siblings) had:
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input

*The informed consent below applies to all Cordlife’s banking services you have enrolled for this pregnancy. The maternal blood test results and Medical Director’s decision may be required to determine eligibility of storage.

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

I understand that appropriate confidentiality will be maintained for all patient records concerning the Service, but that the Department of Health, or other government agencies may inspect records in accordance with applicable laws or regulations. I therefore certify that I have answered the above questions truthfully and to the best of my knowledge.
Invalid Input

Minimum amount to pay is HK$5,000
Invalid Input
0.00 HKD

Invalid Input