Blood Transfusion Consent Form

Consent Form for Blood Donation
Blood Donor Service
Name
First NameLast Name
Date of Birth
MonthDayYear
Date
Email
example@example.com
Age
Please enter your blood group:
By signing below, I understand that I will be notified of test results that are important to my health or which may affect my eligibility to donate blood, including the results of testing for HIV (the AIDS virus).
My signature below indicates I have read and understood the information above. I understand there are rare risks involved with blood donation. I understand these risks. I understand that my blood will be tested for the diseases listed above and that some positive test results by law must be reported to the Department of Health. I hereby give permission to make a blood donation.
Donor's Signature
Clear
Date
In the case of the donor's age less than 18:
Name
First NameLast Name
Parent's Signature
Clear
Date
Should be Empty:

Consent Form for Blood Donation