Mount Sinai COVID-19 Plasma Donation-Midtown

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

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 to donate plasma.

First Name *

Last Name *

Date of Birth *

YYYY

Sex *

Female

Male

Please enter your home address. *

Please enter your zip code. *

Please enter a telephone number where we can contact you about your results. *

Please enter an email address where we can contact you. *

Did you have COVID-19 or have antibodies in the last 3 to 5 months? *

Yes

If you have high antibodies, would you like to donate plasma? This will allow our teams to contact you to schedule an appointment for plasma donation if you meet criteria. *

Yes

Clear form

Never submit passwords through Google Forms.

This form was created inside of MSW Heart. Report Abuse

Forms