Mount Sinai COVID19 Serum Donation
We are a group of community advocates assisting Mount Sinai to find volunteers to donate blood to fight COVID19!

 If you had COVID and have recovered you can help save a life. Your blood may contain antibodies that fight the virus and can help critically ill people. Mount Sinai is looking to screen you as a volunteer. Please fill out this form to see if you are eligible.

Criteria to volunteer:
If you tested positive for COVID 21 days or more ago and have fully recovered [no symptoms] for the last 14 days or more.

If you were presumed to have COVID 19 with symptoms starting 21 days ago and have fully recovered/no symptoms for the last 14 days or more.

Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Please enter your date of birth *
MM
/
DD
/
YYYY
What is the best phone number to reach you? *
Do you have any other number we can contact you?
Please enter your email address *
Where were you located when you first had symptoms? *
When did your symptoms start? *
MM
/
DD
/
YYYY
Did you test positive for COVID19? *
If not, you may still be eligible if you had typical COVID symptoms [fever, chills, cough, body ache, shortness of breath, etc] which started over 21 days ago and fully recovered/no symptoms for the last three days or more.
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of MSW Heart. Report Abuse