Covid 19 – We are fully operational during this time, taking calls 8am-8pm 7 days a week.
If your partner cannot attend the birth please provide your birthing partner's details here.
If you have lived at your current address for less than 3 years please provide all addresses you have lived at in the last 3 years below.
To store your cord blood and cord tissue safely, we need to ask you a few questions. We appreciate that some of these questions may seem very personal and sensitive. Please be assured your answers will be treated in strictest confidence. Your answers to these questions inform how we store your cord blood and/or cord tissue, and any considerations for the suitability for future medical application.
Please indicate your answer to the following. If you answer YES to any of the following questions, please provide further details in the section provided.
The following are some simple definitions which need to be understood and are deemed agreed by you.
Please note that:
You understand that you have the right and upon reaching 18 years of age, your child has the right to withdraw consent at any time. To withdraw consent, you understand that you will be required to complete a consent form to dispose of the cord blood and/or cord tissue. Once this has been received at Biovault the cord blood and/or cord tissue will be disposed of in accordance with the company’s procedures.
You understand that you have the right and upon reaching 18 years of age, your child has the right to withdraw consent at any time to the processing, transfer and holding of any personal data. However, if you withdraw your consent Biovault will not be able to provide the services and the cord blood and/or cord tissue will have to be disposed of.
You understand that on receipt of a request for disposal Biovault may ahead of the disposal perform additional tests on the cord blood and/ or cord tissue as part of its ongoing quality assessment processes. The results of these tests will be for Biovault use only and will not be communicated to you.
You understand that if the cord blood stem cells are required for medical application the data including your personal data will, in accordance with the law, be held for 30 years post use and even if you withdraw your consent Biovault must continue to hold that data.
In signing this form or submitting a marked as read version via our online platform at www.biovaultfamily.com you acknowledge:
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