True Diagnostics - Request Donor » Find and donate Plasma to fight Covid

COVID-19 Convalescent Plasma Request Form

Note : All * fields are mandatory

Full Name*

Age * (18 - 60 only)

Sex* Male Female Other

Mobile*

Blood Group: *

Select State: *

Select City: *

Address*

Upload Doctor Prescription *

Date of Positive Covid Test *

If you have subsequently tested negative, what was the date of negative report?