Blood Donor Screening Form Template
A four-step donor questionnaire covering blood type, donation history, health screening and consent.
- Free to use and customise
- No code — everything is drag and drop
- Embed anywhere — one snippet, any website
What this template uses
- Stores leads and can notify you by email
- Connects to CRMs and supports webhooks
This is the real template — step through it, but submissions are switched off here.
About this template
A donor questionnaire is long by necessity. Splitting it across four steps makes it answerable: personal details, blood type and observations, donation history, then health screening and consent.
Donors can complete it before they arrive, which shortens the appointment and gives the clinician something to read rather than transcribe.
The four steps
- About you - contact details and occupation
- Blood type, weight, pulse, haemoglobin and blood pressure
- Previous donations and recent procedures
- Health screening, medication, surgery and consent
Please note: this is a template to adapt, not clinical guidance. Have your own clinical lead review the questions before you use it.
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Make it yours
Change any field, formula or colour. Then embed it on your website.
Start free with this template ↗