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Pregnancy details
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    Parents' Details
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Pregnancy Details
Select Birth type *
Select Planned mode of delivery *
Expected Birth Date *
Where are you delivering your baby? *
Any existing family health conditions?

Important note: It is important to declare any existing conditions such as Hep B, Hep C, HIV or Syphilis. If the mother’s blood tests positive for any of these infectious diseases, CordBank will be unable to store the baby’s cord blood.

Lead Maternity Carer Details
Full Name *
Phone Number *

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