現在の保管者数(11/02現在)
42,198
これまでの採取実績病院数
1,890施設

Enrollment Form


We will send the document (within 33 pages)
in cord blood storage free of charge.

Documentation
destination

Required

Please choose one of above

Pregnant mother's information

First Name

Required

Ex: Hanako

Last Name

Required

Ex: Tanaka

Home address

Homeland address

If you plan to deliver at homeland, please fill in below contact information

Zip code

Required

Ex: 1050004

Prefecture

Required

Ex: Tokyo

City address·
room number

Required

Ex: Minato-ku Shinbashi 5-22-10-2F

Building name

Ex: Matsuoka Tamura-cho Building

Name of the Family

Required

Ex: Matsuoka Family

Phone number

Required

Ex: 0354085279

Email address

Ex: sci

@

Ex: stemcell.co.jp

Your due date

Hospital for birth plan

Prefecture

Please answer to the following questions.

How did you get to know
Stemcell?

※Multiple answers are allowed

In the case of "Internet" or "Other", please specify.

If you are a repeater
Please answer the following questions.

Hospital in which
you gave last birth

Those who come multiple name
Please enter the last of your birth facility name and
your birth date

The last of your due date

 

Please enter if you have any questions.
please tell us if you are a multiplegestation.

Please read our privacy policy and tick the check box if you accept.
Otherwise the information you have entered will not be sent to us.