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    Cord blood donation - Request for information

    Have you read the brochure and do you want to donate umbilical cord blood? Then request the registration form from Sanquin by filling in the form below. 

    Please note: Due to limited resources (such as the training of midwives and gynecologists), it is only possible to donate cord blood in a hospital or birthing center that collaborates with the Cord Blood Bank of Sanquin.
    Please fill in your estimated due date here.
    In which hospital will you be giving birth?
    It is only possible to donate cord blood in a hospital or birthing center that collaborates with the Cord Blood Bank of Sanquin.
    Fill in the name of the midwife or gynecologist who is overseeing your care here.
    DD-MM-YYYY - With your date of birth, we can find you in our records.
    I voluntarily give permission to the Sanquin Umbilical Cord Blood Bank to collect umbilical cord blood and make it available for the treatment of patients. I understand that by doing so, I cannot claim the product for myself.
    If the umbilical cord blood is not suitable for the treatment of patients, I agree that the donated blood will be used for scientific research in recognised research institutes.