Read the three types of contracts (A, B, C) and the rest of the forms. Fill them in carefully!
Each of the three contracts was sent to you in three copies. Please, fill in your personal information in I.D., the date (at the beginning and at the end) and sign them.
VERY IMPORTANT: Your option regarding the payement must be an unitary one. Either you decide to pay in only one instalment or in three instalments, your option has to be the same both on “Contract A” and “Contract C”. For example, you cannot choose one instalment for “Contract A” and three instalments for “Contract C” (or viceversa).
You shall also fill in, sign and write the date on the placental blood shipping application. Do not forget to fill in the fields concerning the probable date of delivery, the hospital and the name of the doctor who will assist your delivery; it is also VERY IMPORTANT to fill in your mail address where you will receive the collection kit, the blood sampling results and the invoice. It is important to write down your phone numbers.
The placental blood sampling application shall be also filled in, signed and dated.
The blood sampling chart (green) shall be filled in only with mother’s personal information (name and date of birth) and with baby’s name (if you have already made a decision about its name).
The confirmation chart (yellow) shall be filled in with your name and signature, without ticking the date (the date shall be filled in by the doctor after delivery).
For further information, read the attached files:
Contract A, Contract B, Contract C
Application on sampling umbilical blood and providing the necessary services
Application on placental blood shipping
The blood sampling chart (green)
The confirmation chart (yellow)
BEWARE! Compulsory fields are marked in color ONLY on the forms downloaded from the site, and they are meant to help you identify more easily the blanks to fill in.
Fields marked in yellow are COMPULSORY. Fields marked in pink are OPTIONAL.