Donation for Thalassaemia Patients,Non-Governmental Organization for Thalassaemia,Blood Donation for Thalassaemia Patients,NGO for Thalassaemia

Current Events

World Thalassemia Day, May 8th 2010

Be A Part

Donate Blood

Where to Donate?
How to Donate?

Support a Child
   Click here to download donation form

Support a Society
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Become a member
   Click here to download registration form

THALASSEMIA CENTER
Thalassemics India
A-9, Nizamuddin West, New Delhi - 110 013 (INDIA)
Tel : +(91)-(11)-24353871, 41827334
Fax : +(91)-(11)- 24353871
E-mail : thalcind@yahoo.co.in

Blood Donor Registration Form

(* represent Compulsory Fields)

*Name (In Capital Letters) Mr./ Ms. Mrs.
*Blood Group
*Age
*Sex
Nationality
*Fathers / Husband's Name
*Address (Residence / Telephone)
Place of work / study Telephone
Mobile No.
Your E-Mail :

History of past illness (Mark)

Jaundice (Hep- A, B o C)
Cancer
Tuberculosis
Any Heart Disease
Diabetes (if on insulin)
Abnormal Bleeding Tendency
Acute Respiratory Disease/ Asthma
Convulsions

Drug addiction/alcoholism
Sign & Symptoms Suggestive of AIDS
Any skin disease on the puncture site
Polycythaemia Vera
Malaria
Breast Feeding/ Mensturation
Recent Immunization
History of Blood Transfusion

Any Major Surgery
Abortion/ Pregnancy
Typhoid
Tattoo
Unexplained Wt. Loss
Epilepsy
Leprosy
Schizophrenia

Any other disease

*Weight

*Height

*Would you like to be a regular Donor

Yes

When did you donate last

How often would you like to donate

3 Months
6 Months
1 year and more

*Enter the code shown on image:

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