COVID-19 Convalescent Plasma Donor Request Form

Thank you for your interest in our COVID-19 Convalescent Plasma Donation Program.

While convalescent plasma is not a proven treatment, it is possible that this plasma, taken from individuals who have recovered from COVID-19 and has antibodies against the virus, could help.

  • If you had a positive confirmed test AND
  • Your symptoms have been gone for 28 days AND
  • You are willing to DONATE your plasma, please complete and submit the form below

– OR – 

  • If you had a confirmed positive RNA (Nasal swab) test AND
  • Your symptoms have been gone for between 14 and 27 days and
  • You have had a second NEGATIVE RNA (Nasal swab) test* AND
  • You are willing to DONATE your plasma, please complete and submit the form below

* To date Geisinger Hospital is offering a free nasal swab test for donors who had documented positive COVID-19 testing and are symptom free between 14 and 28 days. Call 570-284-3657 for more information.  Geisinger is the only hospital system to offer this service. If other facilities offer this service, updates will be posted here as they become available.

All information provided will be kept confidential and will only be used to qualify you as a donor.
NOTE: Presenting donors are asked to bring a face mask or face covering if possible.

Please complete the form below. If Miller-Keystone Blood Center determines you are an eligible donor
for this Convalescent Plasma program, we will contact you within 24 hours for additional information
and advise you how to schedule your donation at one of our six locations.

* required field

Covid Plasma Donor Request Form

Convalescent Plasma – Attestation Form

– COVID-19 convalescent plasma has not been approved or licensed by the FDA; 
– COVID-19 convalescent plasma has been authorized by the FDA under an EUA; 
– COVID-19 convalescent plasma is authorized only for the duration of the declaration that circumstances exist justifying the authorization of the emergency use of drugs and biological products during the COVID-19 pandemic under section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner.