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45 Horsehill Road, Cedar Knolls, NJ 07927

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Home
Learn More
Nest Steps
My Account
877-543-3226
Enroll Now

Online Screening Tool for Donor Eligibility

Are you 18 years of age or older?*

Yes

No

Are you currently between week 24 and week 34 of your pregnancy?*

Yes

No

Did this pregnancy involve the use of an egg or sperm donor?*

Yes

No

Did this pregnancy involve an adoption case or the use of a surrogate?*

Yes

No

Is this a single birth pregnancy? (Note: If you are expecting twins, triplets, etc., then you have a multiple birth pregnancy.)*

Yes

No

Are you able to answer questions about the medical histories for your immediate family and that of the baby's biological father?*

Yes

No

Preliminary Screening Result

Given your responses to the questionnaire, you are NOT eligible to donate your afterbirth.

Please enter your contact information below if you would like information about privately banking your newborn's stem cells. Thank you for your interest!

Mother's Full Name*

Father's Full Name

Mother's Email Address*

Father's Email Address

Mother's Phone Number*

Father's Phone Number

Preliminary Screening Result

Based on this preliminary screening, you are currently eligible to donate your afterbirth. A more detailed health questionnaire and your signed consent are still required as part of our donation process. Please enter your contact information below, and we will reach out to you via Adobe E-sign.*

Agree

Mother's Full Name*

Father's Full Name

Mother's Email Address*

Father's Email Address

Mother's Phone Number*

Father's Phone Number

This field should be left blank

When you work with us, we see more than stem cells — we see your family’s hopes and dreams for a healthy future! That’s why we devote our time, talents, and investments to the proper processing and treatment of your baby's cells that could improve your family’s health.

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Pricing & Packages Cord Blood Banking Placental Banking Sibling Program

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CONTACT US

170 Park Avenue
Florham Park, NJ 07932
info@lifebankusa.com
(877) 543 - 3226

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