Please provide the details of the healthcare professional that will carry out the collection on the day:
*optional
To store your cord blood and cord tissue safely, we need to ask you a few questions (33). We appreciate that some of these questions may seem very personal and sensitive. Please be assured your answers will be treated in strictest confidence. Your answers to these questions inform how we store your cord blood and/or cord tissue, and any considerations for the suitability for future medical application. Please indicate with a tick Yes/No your answer to the following. If you answer YES to any of the following questions, please provide further details in the section provided or below in the box indicated if more space is required.