UWIBDF Twenty-First Voluntary Blood Drive Appointment

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Thank you for your interest in attending the UWI Blood Donor Foundation Twenty-First Blood Drive on Saturday 28th August, 2021. Please make an appointment by selecting the time that you would be available on the day. Complete the questionnaire so that we can do our best to ensure that the process runs smoothly for you.

Note that due to the COVID-19 regulations there is a restriction to the number of people who can register for each time slot.

Leave a mobile phone number as we will be communicating with you via WhatsApp.

If you have any problems filling out this form, contact 390-1611 to make an appointment.

If you are arriving with someone who is also donating please ensure that they make an appointment as well. We cannot guarantee that persons without appointments will be able to donate as space is limited.

Email *

1) First Name *

2) Last Name *

3) Time

4) Mobile phone number *

5) Gender *

Male

Female

6) Date of Birth- Date *

7) Date of Birth- Month *

8) Date of Birth- Year *

9) General Area of Residence *

East

West

Central

South

North

10) Did you ever donate blood at the Eric Williams Medical Sciences Complex (Mt. Hope hospital)? *

Yes

I registered at the blood bank but could not donate blood

11) If you answered yes to question 10, please indicate the date or general time period when you last donated at the Eric Williams Medical Sciences Complex.

12) Would you have mobile data on the day of the blood drive (August 28th)? *

Yes

13) What form of transport will you be using to arrive at the blood drive? *

14) If you are getting a drop with a private vehicle, would you be able to wait on your turn in the vehicle or would you need to proceed to the waiting area on arrival?

I would be able to wait on my turn in the vehicle

I would need to proceed to the waiting area on arrival

Clear selection

15) Will you be arriving with someone who also plans to donate at the blood drive? *

Yes

16) If you answered yes to question 15, please indicate the donor's name(s) below.

17) If there are any specific issues that you would like us to know about, please indicate below.

A copy of your responses will be emailed to the address you provided.

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