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Convalescent Plasma COVID-19 Donor Request Form

Thank you for your interest in convalescent plasma donation and joining our mission to save lives. Please complete and submit the form below if:

  1. You have a lab-confirmed positive test for COVID-19 virus, OR a positive recovery test showing immunity
  2. Your symptoms have been gone for at least 14 days
  3. You are willing to donate plasma (you will be contacted to ensure you meet FDA donor eligibility requirements)

All information provided will be kept confidential and will only be used to qualify you as a donor.

IMPORTANT REMINDERS:
  • Documentation of a positive test is required to donate (can either be provided upon submission of the below form or while scheduling your appointment)
  • Results must be a non-editable document (text messages will not be accepted)
  • Document must include your full name, testing facility or physician, test name, date, and result
  • When presenting to donate, donors are asked to bring and wear a face mask or face covering
     

Please complete and submit this form:

*Required fields

DOCUMENTATION OF A POSITIVE TEST (EITHER NASAL SWAB OR BLOOD ANTIBODY) IS REQUIRED TO DONATE

NOTE: DOCUMENTATION MUST CONTAIN YOUR NAME; TESTING FACILITY OR MD NAME; TEST NAME, DATE, AND RESULT

COVID-19 SYMPTOMS INCLUDE FEVER, COUGH AND SHORTNESS OF BREATH