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Donor Registry Form

Thank you for your willingness to donate plasma and help others that are still battling with COVID-19.

To donate, a person must:

  • Have tested positive for COVID-19 in the past
  • At least 18 years old
  • Symptom free for at least 14 days
  • weigh at least 110 pounds

If you meet the initial criteria above, please complete the plasma donor registry form below to help us determine your eligibility, and we will contact you as soon as possible.

COVID-19 Plasma Donor Registry Form

Address

Was your COVID-19 diagnosis confirmed by a lab test? *

Do you currently have any symptoms such as cough, fever, shortness of breath, muscle aches, headache, or sore throat? *

Have you been symptom free for at least 14 days? *

If Yes, have you been retested for COVID-19?

Have you been symptom free for at least 28 days? *

Are you over 110 pounds in weight, in good health and feeling well? *

Have you registered yourself with another plasma donor registry? *

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