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Blood Donation Form Template

Streamline the Blood Donation Process with Ease

Are you struggling to provide the necessary information for blood donation? Our blood donation form template simplifies the process for health clinics, hospitals, or blood banks, ensuring you can easily register as a donor. Customize it to capture essential details, keep your information organized, facilitate communication with donors, and enhance the intake process for healthcare providers. Start using this live template to enhance your donation efforts today.

Use this Template (FREE) Live Preview
Full name
Date of birth
Approximate body weight (kg)
Gender
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Email address
Mobile phone number
Have you donated whole blood in the last 8 weeks?
Yes
No
Not sure
Are you feeling well today without fever or illness?
Yes
No
Not sure
In the past 3 months, have you had a new tattoo or body piercing?
Yes
No
Not sure
In the past 12 months, have you traveled to a malaria-risk area?
Yes
No
Not sure
Are you currently pregnant?
Yes
No
Not applicable
Are you currently taking blood thinners (e.g., warfarin)?
Yes
No
Not sure
Have you ever tested positive for a bloodborne infection (e.g., HIV, hepatitis B or C, HTLV)?
Yes
No
Not sure
Have you ever been advised not to donate blood?
Yes
No
Not sure
Do you have any allergies to medications, latex, or antiseptics?
Yes
No
Not sure
Do you have any chronic medical conditions (e.g., heart disease, cancer)?
Yes
No
Prefer not to say
Have you had any prior reactions to blood donation (e.g., fainting, nausea)?
Yes
No
Not sure
Preferred donation date
Preferred donation type
Whole blood
Platelets
Plasma
Not sure
Type your full name to confirm the information provided is accurate
Date of consent
I consent to be contacted about this donation request.
Yes
No
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Paper art illustration depicting a blood donation form template for FormCreatorAI article.

When to use this form

This template fits any group running a community drive at a clinic, campus, or workplace. Use it to pre-screen donors, collect contact details, and schedule time slots so lines move fast. You can check basic eligibility such as age, weight, and recent travel before anyone arrives. Hospitals, nonprofits, and student clubs save staff time, while donors get clear instructions and reminders. If you also accept monetary gifts, add a Nonprofit donation form. Raising funds with merch or snacks? Pair this with a Fundraiser order form to track items and pickup.

Must Ask Blood Donation Questions

  1. What is your age and approximate weight?

    These basics determine eligibility for whole blood and other components. Clear ranges reduce back-and-forth and prevent day-of deferrals.

  2. When did you last donate blood or platelets?

    Your answer confirms the required wait period. It also helps staff plan the right procedure and volume.

  3. Do you currently have fever, cough, or other symptoms of illness?

    This protects recipients and volunteers. It lets coordinators reschedule you without losing your interest.

  4. Have you recently traveled internationally or to malaria-risk areas?

    Travel history can require a brief deferral. Asking now avoids last-minute surprises and keeps the queue safe.

  5. What medications are you taking and do you have any medical conditions we should know about?

    Some medicines and conditions affect eligibility or the type of donation. If you cannot give today, you can still help the event by volunteering via a Food bank registration form.

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