COVID-19 Convalescent Plasma Donor Request Form

If you have fully recovered from COVID-19, your plasma could help create a potential COVID-19 therapy. Read more about our Plasma Alliance’s therapy creation at www.CoVIg-19PlasmaAlliance.org.

Interested in donating to help? Fill out the form below. If you are eligible, an Octapharma Plasma team member will contact you to schedule a donation at a collection site near you.

First Name *

Last Name *

Email Address *

Contact Number *

Street Address *

Address line 2

City *

State *

Have you donated at an OPI center before?

Donation Center *

Last 4 of SSN

Date of Birth

Was your COVID-19 diagnosis confirmed by a lab test? Yes No

Do you have documentation of the test result? Yes No

Did you have any symptoms (fever, cough, shortness of breath)? Yes No