New Donor Registration for George King Bio-Medical
Please complete form to get started in our paid plasma donation program
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Email *
Legal Name: *
Phone Number: *
Date of Birth: *
Home Address: *
Gender: *
What is your bleeding or clotting disorder? *Answer none if interested in our normal donor program. *
Required
Is your activity level <1%? (If VWD or other, please mark N/A) *
If your activity level is over 1%, please list what your activity level runs (Please answer N/A if VWD or other) *
HIV Status? *
Hep C Status? *
Have you donated plasma before? *
Please list medications/treatments used for bleeding or clotting disorder in the last 12 months: *
How often do you infuse? *Please answer N/A if you have a clotting disorder. *
Are you able to stop treatment for 2 or more weeks without issues? *
Are you a nicotine user? (All types) *
Do you consider your veins to be good and easily accessible?  *
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