About this template
Organizing blood drives and managing donor registries requires absolute precision, reliability, and care. This Blood Donation Google Form Template is designed for hospitals, health clinics, and blood banks to streamline the donor intake process from start to finish. It collects essential donor contact details, demographic information, blood type, and a comprehensive health screening questionnaire—covering vital signs, recent medical procedures, disease history, and medication usage.
Built to save time for medical staff and make the donation process seamless for contributors, this template ensures all necessary pre-screening information is gathered securely before donors arrive at the clinic. By utilizing Doc2Form, organizers can instantly deploy this template to Google Forms, allowing volunteers and staff to review submissions in real time, coordinate drives efficiently, and maintain an organized, up-to-date donor database without complex software setups.
Key features
- Collect detailed donor contact information and blood types in one place.
- Screen for health history, recent medications, and vital signs prior to donation.
- Streamline event coordination for mobile blood drives and hospital clinics.
- Access and manage all donor responses instantly through Google Sheets.
- Fully customizable layout to match your organization's branding.
Use cases
- Hospital and community blood drive registration events.
- Mobile blood collection unit pre-screening intake.
- Nonprofit health organization donor registry signups.
- Corporate wellness blood donation camp coordination.
What this form collects
- Full Name (Short answer)Enter your first and last name as it appears on your government-issued ID.
- Birth Date (Date)Please enter your date of birth.
- Gender (Multiple choice)Select how you identify.
- Phone Number (Short answer)Provide a reliable phone number where we can reach you regarding your appointment.
- Email Address (Short answer)Enter your primary email address for appointment confirmations and updates.
- Home Address (Paragraph)Enter your current residential address.
- Blood Type (Dropdown)Select your known blood type, or choose 'Unsure'.
- Current Weight (lbs) (Short answer)Enter your current weight in pounds. Donors typically must meet minimum weight requirements.
- Pulse Rate (Short answer)Enter your resting pulse rate in beats per minute.
- Hemoglobin (Hb) Level (Short answer)Enter your current hemoglobin level if measured.
- Blood Pressure (BP) (Short answer)Enter your current blood pressure reading (e.g., 120/80).
- Temperature (Short answer)Enter your current body temperature.
- Last Blood Donation Date (Date)If you have donated before, enter the approximate date of your last donation.
- Have you donated blood before? (Multiple choice)Select your donation history status.
- Recent Procedures (Last 6 Months) (Multiple choice)Have you undergone any tattoos, piercings, acupuncture, or major medical procedures in the last 6 months?
- Disease History (Multiple choice)Have you ever tested positive for HIV, Hepatitis, or other blood-borne infections?
- Recent Medications & Exposures (Past 72 Hours) (Paragraph)List any medications, antibiotics, or vaccines you have taken in the last 72 hours.
- Recent Surgery or Transfusion History (Last 6 Months) (Multiple choice)Have you had any surgeries, blood transfusions, or organ transplants in the past 6 months?
FAQ
What information does this blood donation form template collect?
It gathers core contact details, demographic info, blood type, vital signs (such as pulse, blood pressure, and temperature), weight, recent medication use, surgical history, and previous donation records.
How do I customize this template for my clinic or organization?
With Doc2Form, you can instantly convert and customize this template in Google Forms. You can easily add, remove, or edit questions, include your organization's logo, and adjust settings to fit your specific medical intake protocols.
Where are the donor submissions stored?
All form submissions are securely routed directly to your connected Google Sheet, making it easy for medical staff and coordinators to review data, track donor statistics, and export records when needed.
Can donors fill out this form on their mobile phones?
Yes, Google Forms are fully responsive and optimized for mobile devices, allowing donors to complete their registration and health questionnaire conveniently from a smartphone or tablet.
Is this blood donation template free to use?
Yes, this template is completely free to use, copy, and adapt for your clinic, hospital, or nonprofit organization's blood drive campaigns.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.