Convalescent Plasma Donor Questionnaire

Thank you for giving hope to people critically ill with COVID-19 by considering convalescent plasma donation. Your donation could help save the lives of as many as four people.

If you are interested in becoming a plasma donor please complete the form below.


* = required field

ELIGIBILITY

Let's see if you are eligible to donate plasma:

STEP 1

If you answered 'YES' go to STEP 2. If you answered 'NO', go to STEP 3.

STEP 2

If you answered 'YES' you may be eligible to donate plasma! Fill out the Contact Information below to continue. If you answered 'NO', then you are not eligible to be a plasma donor at this time. Please check back often as requirements may change.

STEP 3

If you answered 'YES' you may be eligible to donate plasma! Fill out the Contact Information below to continue. If you answered 'NO', then you are not eligible to be a plasma donor at this time. Please check back often as requirements may change.

CONTACT INFORMATION

Coronavirus/COVID-19