If you plan to give birth in Bratislava, please enroll here.
You will be noticed of potential mistakes while filling this form. Correct and complete filling of this enrolment form is essential for quick and accurate data processing. This enrolment is not binding. After successful enrolment we will send you documentation and information materials about further procedures.

Mother’s data
Family Name:*

First Name:*

Title:

Postal address* (street, number):

City*:

Postcode*:

Telephone*:

E-mail address*:

Date of birth* (dd.mm.yyyy):

Multiple pregnancy mark here.

If you have already used our services, pleas mark here.

Chosen maternity hospital*:

Obstetrician:

Way of payment:

Which source of information was the most important for you to decide for cord blood collection?

Father’s data:
Family Name:

First Name:

Telephone:

Comment:

I was informed about privacy protection regulations*.

Your enrollment was successful. Within 7 days after processing of your data we will send you information about further steps and documentation for you to be signed and send back to our address. If you have any further question please contact us by email: registracia@eurocord.sk