Order collection kit, order umbilical cord blood  

SAVE FOR LIFE NOW

 
If you feel ready, the form below will allow you to register with us immediately. Just fill out the required data, click the "send" button and we will dispatch a collection kit to you right away.

Should you be closer than one month to your delivery date, we advise you to call one of our customer service representatives on +971 800 2796 in addition to completing the form below.

 

 


 

Fields marked with * are mandatory.


Mother's first name*
Mother's last name*
Father's first name
Father's last name
Street/Number*
Postal code
City*
Country*
Telephone number*
Mobile number
E-mail address*
Name doctor
Name hospital
City
Telephone number
My due date*
Number of births
I heard via:
 
Yes, I will pay AED 3,000 after receiving the invoice*
I agree to the price of AED 10,000 for the processing and the storage*
I would like to pay using HAYATI finance

 

If you would like to pay by creditcard, please fill in this form.

If the shipment address is different from your home address, please fill in the fields below.

 

Name
Street/Number
Postal code
City
Country
Remarks


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