Request blood for a patient

Tell us the group, the hospital and your number. A coordinator calls you back. In an emergency, phone 081-2836820 first.

Blood group needed *

Who the blood is for

Patient name *

Gender *

Age *

Case or disease *

Do you have the medical report? *

What is needed

Type of blood *

Number of bags *

Date needed *

Time

How urgent *

Where

Hospital *

The attendant

Attendant name *

Attendant phone *

Attendant blood group

Can the attendant donate? *

Can you arrange an exchange donor? *

Can the donor be brought to the branch? *

Full address

Town *

What I have entered is accurate, and I agree to be contacted about it.