Emergency Blood Donation Consent Form
Donor Information
Full Name
Date of Birth
Gender
Address
Phone
Email
Blood Group
Emergency Contact
Name
Relationship
Phone
Health Questionnaire
Have you experienced any illness in the past month?
Are you currently taking any medications?
Any known allergies?
Other relevant information
Consent Declaration
I hereby consent to donate my blood during this emergency and declare that the information provided is accurate to the best of my knowledge.
Donor Signature
Date
Witness Name
Witness Signature