Platelet Donation Consent Form
Donor Information
Full Name
Date of Birth
Address
Phone Number
Medical Declaration
I confirm that I have read and understood the information provided about platelet donation.
I declare that I am in good health and have disclosed all relevant medical information.
I understand that this donation is voluntary and I may withdraw consent at any time.
Additional Comments / Relevant Medical Information
Consent
I give my informed consent to donate platelets.
Donor Signature
Date
Witness Signature
Date