Plasma Donation Form from RHA Nepal
Hello. Heroes without capes. Never underestimate the power of a single act of kindness to make a significant difference in someone's life, it may just be the added lift that someone needs to go from falling to flying!
Kindly fill this form if you are someone who have recently recovered from COVID-19 and are willing to donate plasma and save someone's life.
Note - Data of eligible donor will be kept confidential with restricted access.
We will get in touch with them in case of immediate and urgent requests.
If any queries, Email us at
robinhoodarmynepal@gmail.com

Join us today as a Plasma Donor and help Save a Life!

Sign in to Google to save your progress. Learn more
Name *
Age *
Contact Number *
Gender *
If you are a female, have you ever been pregnant?
Clear selection
Weight *
Blood Group *
Province No. *
District *
Place/Tole *
Were you Covid-19 positive? *
Nearest Hospital *
Date of positive report *
MM
/
DD
/
YYYY
Date of negative report *
MM
/
DD
/
YYYY
Have you taken any Covid vaccine? *
Are you a Robin?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy