Blood Donation - Consent Form

Blood Donation - Consent Form

Use this form to gather all the medical information needed from blood donors, Such as blood type, medical history, etc. Perfect for institutions that make blood donation campaigns. Form Preview
  • BLOOD DONOR QUESTIONNAIRE

    AND

    CONSENT FORM

  •  -  - Pick a Date
  • Type of Donation: R/V
  • CONFIDENTIAL

  • ***Please answer the following questions correctly. This will help to protect you and the patient who receives your blood.

  •  -
  •  -
  •  -  - Pick a Date
  • For women donors:

  • General Physician Examination:

    Weight:___________ Pulse:__________ Hb__________

    BP:_____________ Temperature:__________________

  • Signature of Medical Officer: _______________________

  • BLOOD SAFETY BEGINS WITH A HEALTHY DONOR

  • Should be Empty: