Blood Donor Medical History & Consent
Personal Information
Full Name
Date of Birth
Email Address
Phone Number
Address
Medical History
Have you donated blood before?
Are you currently taking any medications?
Do you have any chronic medical conditions?
Have you had any recent surgeries or major illnesses?
Any allergies?
Other relevant medical details
Consent
I hereby consent to provide accurate medical history and agree to the terms of blood donation.
Signature
Date