Register to Give Blood
'Give Blood, Spread Love, England', part of the Sickle Cell Society, is registering new blood donors to help address the need for more people of black heritage to give blood.
There is an urgent need for more black and mixed race blood donors so that people with sickle cell disorder can be treated with the ethnically matched blood they need. Treatment is more effective when blood is received from someone from a close ethnic match. Currently only 1.5% of people who donate blood are of black heritage.
Most people can donate blood, including those with sickle cell trait and/or thalassemia trait.
Please register via this form so we can link your interest to the Sickle Cell Society.
By completing this form you are agreeing to being contacted by Sickle Cell Society, NHS Blood and Transplant (NHSBT) or one of its agents with information about making an appointment to donate blood.
ALL OF YOUR INFORMATION IS PROCESSED IN LINE WITH DATA PROTECTION LEGISLATION.
WE CAN ONLY REGISTER PEOPLE WHO LIVE IN ENGLAND.
WALES, NI AND SCOTLAND HAVE THEIR OWN BLOOD DONATION SERVICES. PLEASE CONTACT THEM DIRECTLY.
If you have a question about sickle cell disorder and blood donation, please contact:
THANK YOU. ONE BLOOD DONATION CAN IMPROVE OR SAVE THE LIVES OF UP TO 3 PEOPLE.
BEFORE YOU COMPLETE THE REST OF THIS FORM, PLEASE CHECK BELOW THE COMMON REASONS THAT MAY PREVENT YOU FROM GIVING BLOOD. YOU MUST BE ABLE TO TICK ALL OF THESE BOXES TO PROCEED WITH THIS FORM. FURTHER CHECKS WILL BE CARRIED OUT PRIOR TO YOUR BLOOD DONATION APPOINTMENT.
I am in general good health and fitness
I weigh between 7st 12lbs (50kg) and 25st (160kg)
I am aged between 17 and 65
I have NOT had a blood transfusion since 1 January 1980
I am NOT pregnant
I do NOT have sickle cell anaemia
I do NOT have thalassaemia
I have NOT been told by a doctor that I can't give blood due to low iron levels
I have NOT received donated eggs or embryos since 1 January 1980
Please tell us your date of birth (DD/MM/YYYY)
I do not identify with either of the above
Address (PLEASE PROVIDE YOUR FULL ADDRESS, INCLUDING YOUR POSTCODE)
London Borough (PLEASE SELECT YOUR LONDON BOROUGH IF APPLICABLE, IF YOU LIVE OUTSIDE OF LONDON, PLEASE SELECT OPTION 1.)
I do not live in London
Barking and Dagenham
Hammersmith and Fulham
Kensington and Chelsea
Richmond upon Thames
Phone number (PLEASE PROVIDE A MOBILE NUMBER IF YOU HAVE ONE)
What is your ethnic group? Tick one option that best describes your ethnic group or background
ANY OTHER BLACK African/Caribbean background
MIXED White and Black African
MIXED White and Asian
ANY OTHER MIXED/Multiple ethnic background
ASIAN Any other Asian background
WHITE English/Welsh/SCottish/Northern Irish/British
WHITE Gypsy or Irish Traveller
WHITE Any other White background
OTHER Any other ethnic group
I prefer not to say
If you DO NOT wish to donate close to home. Please tell us where you would like to donate. (Give us the name of the town or postcode.)
We would like to keep you informed about our work on blood donation. Are you happy for us to do this?
How did you hear about this form?
Give Blood, Spread Love (Social)
'Play a Part' Campaign
Sickle Cell Society Website
Brenda Smith - 40 For 40 Campaign
Utility Warehouse /Jenifer Ingleton
Pursuit of Happiness
Group Blood Donation Day at Tooting Blood Donor Centre
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service