Blood request · verified by a real call

Request blood.

Fill this with the requisition slip in hand. A coordinator calls you to verify, only then are donors contacted. We never ask for patient details.

Your name *

The patient's relative or friend.

Your mobile number *

+91

Hospital *

Where the blood is needed, from the requisition slip.

District * Choose the district BajaliBaksaBarpetaBiswanathBongaigaonCacharCharaideoChirangDarrangDhemajiDhubriDibrugarhDima HasaoGoalparaGolaghatHailakandiHojaiJorhatKamrupKamrup MetropolitanKarbi AnglongKokrajharLakhimpurMajuliMorigaonNagaonNalbariSivasagarSonitpurSouth Salmara-MankacharSribhumiTamulpurTinsukiaUdalguriWest Karbi Anglong

Blood group needed *

A+A−B+B−AB+AB−O+O−

Component Whole blood Packed red cells (pRBC) Platelets Plasma Cryoprecipitate

Units

123456

Needed by *

Urgency

Routine Urgent Emergency

A coordinator may call me on this number about this request.

Submit request

Problems with the form? Call a coordinator, they can take the request over the phone.