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Consultation Form
* Indicates required question
Name 姓名 (as Per IC) *
Email Address *
Age 年龄 *
Gender 性别
Male 男
Female 女
Phone number 电话号码 *
Race 种族
Malay 马来人
Chinese 华人
Indian 印度人
Others 其他
Status 婚姻状况
Single 单身
Married 已婚
Divorced 离婚
Widowed 寡妇
Number of children 孩子人数
Annual Family Income 家庭年收入
Less than RM30,000
RM30,001 – RM100,000
RM100,001 – RM200,000
More than RM200,000
Have you heard about any of the below services? (can choose more than 1)
你有听过以下任何的服务吗？(可选择多过1项）
Cord Protein Banking (CEXCI) 脐带蛋白库
Cord Blood Banking 脐带血库
Wharton’s Jelly 华通氏胶/Mesenchymal Stem Cell (MSC) Banking 间充质干细胞库
Do you know CEXCI cord protein banking technology is the first in the world?
您是否知道 CEXCI 脐带蛋白是世界首创科技吗？
Yes 是
No 否
Do you know Cell Genesis Laboratory is based in Singapore?
您是否知道我们公司的实验室总部在新加坡？
Yes 是
No 否
If CEXCI cord protein could cure >40 incurable diseases, would you opt for it?
如若 CEXCI 脐带蛋白能够治愈超过 40种不治之症，您会选择吗？
Yes 是
No 否
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