Requesting Brochure & Contract

・If you (or your family)are currently pregnant and considering storage,
　we will send to your email address the necessary brochures and contracts.
　Please fill in the required fields below and submit.
・Advance preparation, such as collection kits, are required for storage of cord blood.
・If your due date is close, a representative will contact you shortly.
　Please make sure to enter your due date correctly.
・Please note that the information you enter on this page is encrypted and transmitted securely.

Please tick if applicable

Please select this option only if you have paid storage.

Pregnant mother's information

First Name
Last Name
Date of Birth of Person Giving Birth

Contact information

Email address
Phone number

Documentation destination

Zip code
Prefecture
City address ·
room number
Building name

Please answer to the following questions.

How did you get to know Stemcell?

If you are a repeater Please answer the following questions.

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

Hospital in which you gave last birth
The last of your due date
  • Year
  • Month
  • Day

Delivery information

Your due date
Hospital for birth plan

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.

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