Consent Form

Consent Form

If you're looking a form for Blood Donation, use this form. 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.

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  •  -  - 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: