Name*

First Middle Last

Have you ever gone by another name?*

Yes
No

Previous Names Used*

First Middle Last

Are you over the age of 18?*

Yes
No

We apologize, but donors under the age of 18 are unable to schedule appointments online. Please complete and bring in the Parental Consent Form to your nearest donation center in order to make a donation.

Date of Birth*

MM

DD

YYYY

Will this be your first time donating with The Central California Blood Center?*

Yes
No

We apologize, but first-time donors are unable to schedule appointments online. Please complete and bring in the New Donor Form to your nearest donation center in order to make a donation.

Phone*

Email*

Preferred Center*

Day of the Week*

Time of Day*

Send me a Reminder of my Appointment via:

Phone Call
Text Message
Email

Advance America

MAKE ONLINE APPOINTMENT

MAKE ONLINE APPOINTMENT

DON'T KNOW YOUR BLOOD TYPE?

YAY! YOU KNOW YOUR BLOOD TYPE.