Convalescent Plasma Donor Form - Coastal Bend Blood Center

First Name*

Last Name*

Email*

Phone*

Address*

Address 2

City*

State*

Zip Code*

Country*

Do you currently have symptoms?*

Has it been at least 14 days since the last day of your symptoms (COVID-19 symptoms include fever, cough, and shortness of breath)?*

The last date you had COVID-19 Symptoms was:*

Was your COVID-19 diagnosis confirmed by a lab test?*

Have you had a follow-up test that was negative for COVID-19 or shows you no longer have COVID-19?*

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