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Convalescent Plasma COVID-19 Donor Request Form

Thank you for your interest in convalescent plasma donation and joining our mission to save lives. Please complete all information in the form below and submit if:

  1. You have a lab-confirmed positive test for COVID-19 virus, OR a positive recovery test showing immunity
  2. Your symptoms have been gone for at least 14 days
  3. You meet the eligibility requirements to donate blood
  4. You are willing to donate plasma 

All information provided will be kept confidential and will only be used to qualify you as a donor.

IMPORTANT REMINDERS:
  • Documentation of a positive test is required to donate (can be provided upon submission of the below form)
  • Results must be a non-editable document (text messages will not be accepted)
  • Document must include your full name, testing facility or physician, test name, date, and result
  • When presenting to donate, donors are asked to bring and wear a face mask or face covering

 

Please complete and submit this form:

*Required fields

DOCUMENTATION OF A POSITIVE TEST (EITHER NASAL SWAB OR BLOOD ANTIBODY) IS REQUIRED TO DONATE

DOCUMENTATION MUST CONTAIN YOUR NAME; TESTING FACILITY OR MD NAME; TEST NAME, DATE, AND RESULT

COVID-19 SYMPTOMS INCLUDE FEVER, COUGH AND SHORTNESS OF BREATH