.:: BharatBloodBank.com

		A social initiative of BharatMatrimony Enterprise

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Media Centre

Donor registration

Name

Username

(min 6 characters) Check Availability?

Password

(Minimum 4 characters allowed)

Confirm Password

(Please re-enter your password)

Date of Birth

(min: 18 yrs max: 55 yrs)

Date of birth will not be shown to others, its only for calculating your age.

Gender

Female Male

Weight

Kgs
(should be above 50 kg)

Phone

Mobile

Res

Off

(Note: Please provide atleast one contact number. But it is recommended to provide as many contact numbers possible as it would make it easier for the recipients to contact you in a time of emergency. Remember a life may be depending on you.)

E-mail id

* Optional

(We recommend you enter the E-mail id, which will help us to get in touch with you incase you are not reachable by phone)

State

City

Area

Blood Group

Date of last blood donation

* Optional

How often have you donated blood in the past?

Personal Message (Message from donor)

* Optional

I have not suffered from and not taking medication for
Malaria (within 1 year)
Hepatitis B, C *
Any other type of Jaundice (within 5 years)
AIDS
Tuberculosis (within 2 years)
Diabetes (are you under medication currently?)
Fits/ Convulsions (are you under medication currently?)
Cancer *
Leprosy or any other infectious diseases
Any allergies (Only if you are suffering from severe symptoms)
Hemophilia/ Bleeding problems *
Kidney disease *
Heart disease *
Chicken Pox (within 1 year)
Hormonal disorders *
Hemoglobin deficiency / Anemia (recently)
Drastic weight loss (recently)
Small Pox Vaccination (within the last 3weeks)
Blood Donation (within the last 3 months)
Blood Transfusion (within the last 6 months)
Major Surgery (within the last 3 months)
Pregnancy (within the last 6 months)
Organ Transplant (within one year)

* - Please consult your physician to check for eligiblity.

I have read the above eligibility criteria and confrim that I am eligible to
donate blood.

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