Schedule An Appointment - New Donor

All potential donors are screened to see if they are eligible to participate in LeukoLab's donation options. Donors will follow the easy 3 step process below prior to donation.

Donor Screening Process

Contact LeukoLab using the screening form below for quickest response. Please note it may take up to 2 weeks to hear from us; please be patient! We see many donors at a time and promise to get to your request shortly.

Step 1 - Complete a Donor Screening Form here to begin the process.


Step 2 - If preliminary eligibility is met, LeukoLab will schedule an on-site health screening. We will measure weight, blood pressure and pulse and obtain blood samples to determine full donation eligibility. During this visit you will read, complete screening consent and donation information documents. You will not donate at this appointment.


Step 3 - A LeukoLab representative will inform you if you have met eligibility requirements for any or all of the Donation Options. Once you agree to participate, we will confirm your availability and contact you for a donation. You are ready to donate!

There is no compensation for the screening process.

New Donor Screening Form


Basic Info

Availability:

A majority of LeukoLab donations take place Mon-Thur 7:30am – 1pm and at times require less than 2 weeks notice to commit to a donation. Please confirm that your schedule can accommodate these times:

Yes – I confirm that my availability is within the LeukoLab donation schedule.
No – I am unavailable at these times however would like to be considered for special donations at other times.

Location:

1301 Harbor Bay Parkway, Alameda, CA 94502 and 500 Congress Street, Quincy, MA 02169? We recommend that to join our program you live within 1 hour of a LeukoLab or at least travel to one of our facilities on a regular basis.

Yes – I confirm that I live within 1 hour of a LeukoLab facility (or at least travel to the area on a regular basis). For verification my physical address is:





No – I do not live within 1 hour of a LeukoLab facility.

SSN:

Are you a U.S.citizen with a SSN? Please note: Non-US citizens are not eligible to donate at LeukoLab.

Yes No

Donor Info

* Please note that every item requires an answer.

Please populate your legal name.

First Name:
Last Name:
DOB:
Gender:
M F
Cell Phone:
 -   - 
Weight:
lbs
Ethnicity:
Email Address:

Medical History:

Please answer as accurately as possible and note that our researchers sometimes look for donors with specific medical conditions as well.

Currently pregnant, or breastfeeding?
Yes No
Do you currently use blood thinners such as aspirin (such as for post heart attack, stroke or coronary interventions)?Yes No
Are you taking any other medication (prescription and/or over the counter)?
Yes No
Any known allergies to medications? Yes No

Have you ever been diagnosed with:

High Blood Pressure?
Yes No
High Cholesterol?
Yes No
Significant Anemia?
Yes No
Cancer?
Yes No
Diabetes?
Yes No
Blood Clot/
Bleeding Disorder?
Yes No
Sickle Cell Trait?
Yes No
Hepatitis/HIV?
Yes No
Skin disease diagnosed
by a physcian, such as
psoriasis or eczema?
Yes No
Autoimmune disorders? Yes No
Do you have any conditions or disorders affecting major organs such as:
a. Brain
Yes No
Please specify:
b. Liver
Yes No
Please specify:
c.
Lung
Yes No
Please specify:
d. Heart
Yes No
Please specify:
e. Kidney
Yes No
Please specify:
f. Thyroid
Yes No
Please specify:
g. Gastrointestinal
Yes No
Please specify:

How did you hear about LeukoLab?
Additional Comments:
Anti Spam Code:

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None of the information that we obtain from this screening will be disclosed to anyone other than the LeukoLab staff. The information will be kept confidential and will be password protected to help maintain confidentiality. Remember, your participation is voluntary and completing this donor screening does not obligate you to donate.