American Red Cross New York-Penn Blood Services Region
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Hospital Blood Donation Form

Hospital Blood Donation Form

Thank you from the hospital, and from all the people who will be helped because you give the gift that only you can give... your blood.

To be eligible to donate:

  • You must be at least 17 (16 with parental permission)
  • You must weigh at least 110 pounds

Call 1-800-GIVE-LIFE to schedule an appointment, or make an appointment online.

Please complete the following information to donate on behalf of your local hospital:

Choose one

* Required info
First Name *
Last Name *
Address
 
City, State ,
ZIP Code
Date of Birth *
Phone Number (w/ area code)
E-mail address
Hospital you would like to support with your donation: *
    

American Red Cross Blood Services, New York-Penn Region
825 John Street — West Henrietta, NY, 14586 — (585) 760-5555