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AlphaCord - Preserving Newborn Stem Cells

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  • Read the AlphaCord Client Service Agreement and choose the "I Agree" button.
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Client Service Agreement

Please read the contract below. If you agree, click on the “I Agree” button below and you will be taken to the next step.

CLIENT SERVICE AGREEMENT:
CORD BLOOD AND CORD TISSUE STEM CELL COLLECTION, PROCESSING & STORAGE
Each undersigned, Legal Guardian, on their behalf and the behalf of their unborn child ("Child"), request under this Agreement, that Alpha Cord, LLC. ("Alpha Cord" or “We” or “Our” or “Us”) arrange for the processing, storage and testing of newborn stem cells from umbilical cord blood and/or umbilical cord tissue subsequent to the birth of their Child. Each of the undersigned understands, acknowledges and agrees to the following, legally binding terms of this Agreement, between Alpha Cord and each undersigned, Legal Guardian or Parent (hereinafter, the "Client” or “You" or “Your”).

  1. Nature of Services. These services include but are not limited to Your Healthcare Provider collecting Cord Blood and/or Cord Tissue immediately following the birth of the Child. Subsequent to a successful collection, these newborn stem cells will be shipped to, tested and processed at Our contracted laboratory. Finally, they will be cryopreserved (placed into a long term frozen state), and stored for future use.

  2. Purpose. Newborn stem cells are cryopreserved for possible therapeutic use in the event the Child's stem cells may be needed to treat the Child or other members of the Child's immediate or extended family. You understand and acknowledge that stem cells from alternative sources, such as bone marrow, are currently used to treat various life-threatening conditions such as leukemia, other cancers and blood disorders. You understand Your Child’s newborn stem cells are being stored for possible use by Your Child or other family members who may need a stem cell transplant in the future. You understand cryopreservation of newborn stem cells is a relatively new procedure, and, while laboratory tests and studies thus far have indicated it is a successful method of preservation, no long-term assurances can be made about the effectiveness of preservation. You also acknowledge successfully collecting, storing and transplanting stem cells from the Umbilical Cord and/or placenta does not guarantee successful treatment(s), and that stem cells used in a clinical setting require the prescription of a licensed physician. You also understand the physician or regulations may require supplemental testing in order to allow a transplant to go forward.

  3. Collection of Newborn Stem Cells. We will provide You with a Collection Kit prior to the birth of Your Child including instructional materials. You will be responsible for bringing the Collection Kit to the delivery area and giving it to Your Health Care Professional for the collection of the Cord Blood and/or Cord Tissue. You will also be responsible for making sure the Collection Worksheet is completely filled out and returned with the Cord Blood and/or Cord Tissue so they can be properly identified and stored by the Laboratory. Failure to return a fully completed Collection Worksheet could result in your Cord Blood and/or Cord Tissue not being stored by the Laboratory or being stored in such a way that it cannot be properly identified or located in the future if and when needed.

  4. Shipment of Newborn Stem Cells. You are responsible for the shipment of the collected Cord Blood and/or Cord Tissue to the Laboratory. You are responsible for following the enclosed directions and properly packing the Cord Blood and/or Cord Tissue for shipment to Our contracted laboratory. Alpha Cord representatives will be available by telephone if you need assistance with this process.

  5. Testing and Storage of Cord Blood and/or Cord Tissue. Upon receipt at the laboratory, the samples and any required maternal blood samples will undergo any tests required by the Laboratory. You will receive notification whether the Cord Blood and/or Cord Tissue meet the standards and requirements for storage. It is unlikely yet possible re-testing for infectious diseases after the delivery of the Child may be required to comply with new regulations or new industry standards. If the Cord Blood and/or Cord Tissue is eligible for processing and storage, Our contracted Laboratory will process and maintain the Cord Blood at cryogenic temperatures. We reserve the right, in our sole discretion, to transfer the stored Cord Blood and/or Cord Tissue with or without Your consent to another storage facility during the term of this Agreement at Our expense.
  6. Ownership of Cord Blood and/or Cord Tissue. You agree to be the custodian of the Cord Blood and/or Cord Tissue until the Child reaches eighteen (18) years of age. When the Child becomes eighteen (18) he or she will become the custodian of the stem cells. In the event of nonpayment of any fees that are or become due under the terms of this Agreement, all rights to, title to, and ownership of the stem cells will be relinquished to Us. We may, at sole Our discretion, utilize, donate or dispose of Your stem cells after this Agreement has been terminated for nonpayment.
  7. Retrieval of Sample for Use. In the event the Cord Blood and/or Cord Tissue is requested by a licensed physician for treatment, You shall provide written notification to Us. This notice shall include, but not be limited to, the name and address of the physician and hospital receiving the Cord Blood and /or Cord Tissue. All required physician and hospital orders, paperwork and protocols must be adhered to regarding the release and shipping of the stem cells. You shall be responsible for any and all preparation, shipping or transfer fees or costs incurred by Us. In addition, all fees due to Us must be paid in full prior to a transfer of the Cord Blood and/or Cord Tissue.
  8. Fees. You agree to pay to Us the fees associated with the processing and storage of Your Cord Blood and/or Cord Tissue pursuant to the processing and storage plan/option You have chosen. You agree to pay these fees according to the method of payment and payment plan You have selected. After the initial term of this Agreement has expired, and during any subsequent renewal periods, each year you will be charged an annual storage fee. We reserve the right to change Your annual storage fee to reflect changes in market conditions or any reasonable cost increases We may incur. If a written refund request, signed by You, is received by US prior to, or 60 days after, the Child's birth, all fees You have paid will be refunded. No other conditions for refunds exist.
  9. Term of Agreement. This Agreement shall commence on the date we receive your first payment and it shall remain in force for the length of time specified by the storage plan/option you have selected. Once that plan/option has expired, it shall thereafter renew automatically for additional one year periods unless either party notifies the other party in writing of their intent not to renew this Agreement. A non-renewal notice must be sent at least sixty (60) days prior to the anniversary date of this Agreement.
  10. Termination of Agreement by Client. If You choose to terminate this Agreement, You may elect to have Your Child’s Cord Blood transferred to a different facility. Any fees or expenses relating to the transfer of the Cord Blood as a result of the termination of this Agreement by anyone for any reason will be incurred by You. If You decide to terminate this Agreement, You will not be entitled to a refund of any amounts previously paid. If You do not make arrangements to transfer the Cord Blood and/or Cord Tissue to a licensed storage facility at least 60 days prior to the current term’s termination date, then all rights to, title to, or and ownership of the Cord Blood and/or Cord Tissue will be relinquished to Us, in which event We may, in Our sole discretion, utilize, donate or dispose of the Cord Blood and/or Cord Tissue.  
  11. Termination of Agreement by Alpha Cord. We may terminate this Agreement upon written notice to You if You fail to pay any fees within thirty (30) days of the due date. Upon termination of this Agreement for nonpayment, all rights to, title to, and ownership of the Cord Blood and/or Cord Tissue  will be relinquished to Us, in which event Alpha Cord may, in its sole discretion, utilize, donate or dispose of the Cord Blood and/or Cord Tissue.
  12. Assignment. Alpha Cord May assign this Agreement to any partnership, association, individual, corporation or other entity that provides similar services or intends, after such assignment to provide such services. In order to provide the best possible services to You, Alpha Cord may delegate responsibilities hereunder to one or more subcontractors who perform similar services as part of their regular business activities. We currently contract Our stem cell processing and storage activities to third party laboratories. This Agreement is not assignable by the Client without written notification to and the written consent of Alpha Cord which, in its sole discretion, may or may not be withheld.
  13. No Warranty or Guarantee; Limitation of Liability. You acknowledge that neither Alpha Cord nor the Laboratory nor any of their respective officers, directors, shareholders, executives, employees, agents or consultants have ever made any representations, guarantees or warranties, express or implied, to You of any type or nature, including without limiting the generality of the foregoing, nor have there ever been any representations, warranties or guarantees with respect to (i) suitability of Cord Blood and/or Cord Tissue for future management or treatment of diseases; (ii) successful treatment of diseases by Cord Blood and/or cord tissue; (iii) any advantage(s) of Cord Blood and/or Cord tissue transplantation over other treatments using other stem cells or other therapies; and (iv) the merchantability or fitness for a particular purpose or use of any product or service hereunder. Client agrees that any claim against Alpha Cord or the contracted Laboratory or the assignee of either, including any claim for loss, injury, damage or destruction directly caused by Alpha Cord's failure to exercise reasonable care in all of its services, including but not limited to, the transportation, processing or, storage of the Cord Blood/Tissue, shall be limited to the total amount of fees paid by the Client to Alpha Cord.
  14. Client Consent and Understanding. I hereby consent to and understand the following:
    - I consent to have my healthcare provider collect the cord blood and/or cord tissue after the birth of my child.
    - I understand there are potential benefits to the collection of cord blood and/or cord tissue, including the procurement of stem cells to treat certain diseases, such as certain cancers and blood disorders. However, I understand that treatments based on stem cells are not the best treatment for all diseases, and that stem cell treatment for any particular disease may not be effective. I also understand that it is possible better treatment alternatives may be developed in the future.
    - I also understand there are alternatives to obtaining stem cells from cord blood and/or cord tissue, such as from bone marrow, and stem cells harvested from alternative sources have proven effective in treating the same diseases as stem cells harvested from cord blood and/or Cord Tissue.
    - I understand that my child or my family may never need to use the cord blood and/or cord tissue.
    - I understand the decision to collect the cord blood and/or cord tissue will be made by my healthcare provider at the time of the delivery of my child. I further understand the primary consideration during childbirth will be the health of my child and the birth mother, and circumstances may exist in which the healthcare provider determines it is in the best interests of the child or the birth mother that the cord blood and or cord tissue not be collected.
    - I understand the cord blood and/or cord tissue may undergo various tests required by the Laboratory, including but not limited to, testing for stem cell concentration, nucleated cells, as well as bacteria, viruses and fungi, and the testing may indicate the cord blood and/or cord tissue may not be stored, or may only be stored in a fashion that it is quarantined from other units.
    - I understand the cord blood and/or cord tissue will be stored at cryogenic temperatures pursuant to procedures normal for the industry. I understand it is not known at this time how long cord blood and/or cord tissue can safely and effectively be stored using this process.
    - I understand I will be responsible for delivering the collected Cord Blood and/or cord tissue to the contracted Laboratory I have selected, along with a fully completed "Collection Worksheet" and all other information reasonably required. I also understand it may not be possible to store the Cord Blood and/or Cord tissue if it is not accompanied by the fully completed "Collection Worksheet" and all other identifying documentation, and if the cord blood and/or cord tissue is not delivered in accordance with the procedures delineated by Alpha Cord.
    - If required, I consent to have a sample of my blood (and obtain the consent of birth mother, if different) drawn at the time of the delivery of my child, and to have my blood undergo various tests required by the Laboratory, included but not limited to, infectious diseases, such as Hepatitis B, Hepatitis C, HTLV, cytomegalovirus and syphilis, and Alpha Cord and/or the Laboratory may not store the Cord Blood and or cord tissue if any of the tests are positive.
    - If required, I hereby consent to have my blood (and obtain the consent of birth mother, if different) tested for the presence of antibodies for the Human Immunodeficiency Virus. I understand a positive test result indicates I have been exposed to the Virus and am infected, but it does not mean I have AIDS or I will become sick with AIDS in the near future. I understand a negative test result indicates I am probably not infected with the Virus, although I understand I should be retested if I think I have been recently exposed to the Virus. I hereby consent and authorize Alpha Cord, its laboratories, or any other entity providing services to me to release any medical records or test results on file to any other provider as may be requested or required from time to time. 
    -I (and the birth mother if different) understand there are risks to having my blood drawn, such as bruising, discomfort, redness or inflammation around the needle site.
    -I understand if I direct Alpha Cord not to perform maternal infectious disease testing or to store the cord blood and/or cord tissue in containers other than a sealed dual bag system, the AABB may consider these samples suitable only for autologous use. However, the AABB is only a private accreditation agency and has no governmental or regulatory authority or force of law. The AABB cannot restrict Your decisions when using the cord blood and/or cord tissue for any particular therapy or for an particular recipient.
    - I understand and agree Alpha Cord’s liability for any breach of its obligations or other acts or omissions in connection with the services described in this Agreement is limited to the total amount I have paid to Alpha Cord under this Agreement. I hereby release Alpha Cord, my healthcare provider, the hospital or birthing center and their officers, directors, employees, agents, affiliates, successors and assigns from any and all other liability for any and all loss, harm, damage or claim of any kind arising out of or related in any way to the services provided under this agreement. I understand by this release I am giving up any right I might otherwise have, now or in the future, to sue or otherwise seek money damages or other relief against Alpha Cord (or the other above noted released parties) for any reason relating to the services, with the sole exception of seeking a return of any moneys paid under the Agreement.   
  15. Arbitration. This Agreement shall be governed by and construed in accordance with the laws of the State of Georgia, applicable to contracts made in Georgia, by persons domiciled in Atlanta, Georgia and without regard to its principles of conflicts of laws. Any claim for monetary damages under this Agreement shall be submitted to arbitration with the American Arbitration Association in Atlanta, Georgia and shall be finally and conclusively determined by the decision of a board of arbitration consisting of one (1) member. Any decision made by the arbitrator shall be final, binding and conclusive on the parties to the dispute, and entitled to be enforced to the fullest extent permitted by law and entered in any court of competent jurisdiction. The prevailing party shall be awarded and entitled to recover its reasonable attorney fees and expenses relating to any arbitration.
  16. Notices. Any and all notices that may be given in connection with this Agreement shall be in writing. Any notice(s) shall be deemed to have been duly given on the date of service if served personally on the party to whom notice is to be given, or within 72 hours after mailing, if mailed to the party to whom notice is to be given, by certified mail, postage prepaid, or by a “Next Day Air” service both with a signature from the notified party evidencing receipt. Notices shall be properly addressed to the party at the address set forth on the signature page of this Agreement, or any other address the party has designated by written notice to the other party. The Client agrees to promptly notify Alpha Cord in the event of a change in Client's current mailing address or payment methods at any time during the term of this Agreement or any renewals thereof.
  17. Miscellaneous. This Agreement, represents the entire Agreement between the parties concerning the subject matter hereof, and there are no understandings, agreements, or representations other than as set forth herein. This Agreement is binding upon the parties, their heirs, spouses, executors, administrators, successors and assigns. No modification, amendment or waiver of any provision of this Agreement, nor any consent to any departure by any party from the terms hereof, shall be effective unless the same be in writing and signed by all parties hereto. This Agreement shall be governed by the laws of the State of Georgia. If any provision of this Agreement is held invalid, illegal or unenforceable, the validity, legality or enforceability of the remaining provisions shall in no way be affected or impaired thereby. Alpha Cord shall not be liable for any delay or failure to perform per the terms of this Agreement caused by Acts of God or other causes beyond the parties’ control and without fault or negligence. This Agreement may be executed in one or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument.
    I have read and understand the above agreements, consents, limitation of liability and releases, and know the services described above are totally voluntary and elective on my part. I have discussed the services with my healthcare provider, and I have signed this Agreement freely and voluntarily. By signing this Agreement, I hereby acknowledge that I am giving up legal rights I might otherwise have had. In accordance with Chapter 12: Title 10: Official Code of Georgia Annotated, "Georgia Electronic Records and Signatures Act"; By clicking the "I Agree" button, I hereby affix my signature, signifying my consent and fully binding me to this agreement.

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