Blood Donation Form

Donor Full Name*

Date of Birth*

Phone Number*

Blood Type (if known)

A+

A-

B+

B-

AB+

AB-

O+

O-

Unknown

Have you donated blood in the last 56 days?*

Are you currently taking any medication?*

Have you had any recent illness, surgery, or tattoo in the past 12 months?*

I confirm that I am in good health and consent to donate blood*

Donor Signature*

Signature field

What is this form?

A blood donation form for blood banks and hospitals to screen donors and collect health information before a donation. Ensures donor eligibility and patient safety.

Who is it for?

Blood banks, hospitals, Red Cross chapters, and community blood drive organizers.