EveryLifeMatters
Home
Donate
Request
About
Request for Plasma
Name*:
Gender*:
Male
Female
Other
Mobile number*:
City*:
Blood Group*:
A-
A+
B+
B-
O+
O-
AB+
AB-
Date of positive Covid-19 test*:
I confirm that a doctor has recommended plasma therapy.
I confirm that the data provided to me will be used for medical purposes only.
I confirm that the information provided by me is true and I'll be held responsible in case the information is wrong.
Submit
