GiveRed

Full Name *

Gender*

M

F

Age *

Yrs

Mnth

Days

Personal Details *

Have you tested positive for Covid-19? *

Y N

Do you have COVID-19 negative test report? *

Y N

Address *

City *

Have you donated before? *

Y N

Blood Group *

Organisation Name

Organisation *

Have you ever had a positive test for AIDS virus? *

Y N

Do you have any chronic conditions or anything else we need to know? *

Have you ever been tested positive for Hepatitis B or Hepatitis C? *

Y N

Did you get a tattoo in the past 12 months? *

Y N

Would you be more inclined to donate if the user provides transportation? *

Y N

*

I have read and agreed to Terms and Conditions by GiveRED