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Want to learn more about our services? Complete the form below and we will contact you as soon as possible to provide you with all the information you need and answer your questions.

    We kindly inform you that the personal data provided in the form will be processed by Polski Bank Komórek Macierzystych Sp. z o.o. ("PBKM") with its registered office in Warsaw, Al. Jana Pawła II 29 for telephone contact in connection with the provision of information on the service.

    Abbreviated medical questionnaire

    Abbreviated
    medical questionnaire

    Dear Parents

    Please fill out the medical questionnaire to determine what options for cord blood banking services will be feasible for you. After you complete the form, we will jointly interpret your answers through one of the following methods.

    1. Contact your Medical Consultant by phone immediately after completing the form – then you will receive information on eligibility practically “on the spot”.
    2. Send the completed questionnaire in response to the e-mail you received from your Medical Consultant, and he will contact you to provide information on eligibility for obtaining biological material.

    Medical questionnaire

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