Screening

All fields marked with * are required.

I have read and understand the Blood Donor Educational Material *

I am in a private setting, and will answer the questions without input from anyone else. *

I am completing this interview on the day of my blood donation. *

I am under the age of 18. My parent/guardian has read and understands the Parent Consent Form and authorizes my donation *

Help support the vital mission of

Saving Local Lives