Mangalore Plasma Donors
A citizens' collective to ensure ready availability of plasma donors in Mangalore.

Please read this before you complete the form:

You CANNOT donate plasma if

- You have ever been pregnant
- You received the COVID-19 vaccine in the past 28 days
- You are a HIV patient, kidney transplant recipient, cancer patient, TB patient
- If you underwent surgery or had a tattoo in the past 6 months
Name *
Blood Group *
Email *
Location Area (in Mangalore) *
Phone number *
Date Tested COVID Positive *
MM
/
DD
/
YYYY
Date Tested COVID Negative
MM
/
DD
/
YYYY
I confirm I have recovered from COVID-19 and have not experienced symptoms for 14 days since the day(s) I tested positive *
Required
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