Apply online to become a donor today

Personal Information

Forename(s) *

Surname *

Sex *

Male
Female

Email *

Telephone *

Date of birth *

Address 1 *

Address 2

Town / City *

Postcode *

Occupation *

Physical Characteristics

Eye colour

Hair colour

Skin Tone

Height

Weight

Ethnic origin

You must select one option *

White

British
Irish
Any other white background

Mixed

White and Asian
White and Black African
White and Black Caribbean

Asian or Asian British

Indian
Pakistani
Bangladeshi
Any other Asian background

Black or Black British

African
Caribbean
Any other Black background

Other Ethnic Group

Chinese
Any other ethnic background

Medical History

Is there any history of disease in your family? *

Yes
No

Please give brief details of your medical history

Are you adopted? *

Yes
No

If yes, please provide any medical information for your biological family if known

General information

Have you ever made anyone pregnant?

Yes
No

Have you ever been pregnant?

Yes
No

Are you willing to be tested for HIV and other infections on a regular basis?

Yes
No

How long do you intend to stay in the Manchester area?

Have you ever donated at another centre?

Yes
No

Where did you here about us?

Please state your reasons for wanting to donate

I have read and accept the Privacy Policy

Apply online

Preliminary application for donors

FAQs

Contact us