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Blood Donation Screening Form - Free Healthcare Template | ZenBuild | ZenBuild

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Blood Donation Screening Form

Pre-screen prospective blood donors for eligibility based on health history, recent travel, and lifestyle factors. Ensures donor safety and blood supply quality. Streamlines the donor check-in process at blood drives.

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Blood Donation Screening Form

Complete this screening before your blood donation appointment.

Donor Full Name*

Date of Birth*

Do you feel well today and are you in good health?*

YesNo – I have symptoms

Have you donated blood in the past 56 days (8 weeks)?*

NoYes

Have you traveled outside the country in the past 3 months?*

NoYes – please discuss with staff

Blood Type (if known)

Template Details

CategoryHealthcare

IndustryHealthcare

Fields6

Uses0

Views1

healthcareblood donationscreeningdonorpublic health