Become a Donor -

RakhtSahyog Volunteer System

Full Name Country WhatsApp Number

+91

Email (Optional) Age Gender Blood Group State / Region City / Taluka / Village Full Address with Pincode Availability Status Weight (kg) Approx. Hemoglobin Level (Optional) Any Tattoo or Body Piercing in last 6-12 months? Have you donated blood before?

Last Blood Donation Date

Medical Conditions (Diabetes, BP, Heart, Asthma, etc.) Are you currently taking any long-term Medications? Ready to donate during midnight/emergency? How far can you travel to donate blood? Reference / How did you find us?

Declaration

I hereby confirm that all the information provided by me is true and correct to the best of my knowledge. I understand that my details may be used by RaktSahyog for emergency blood donation coordination and I agree to be contacted via WhatsApp, call, or email when required.

🩸 Become a Donor 🩸

Declaration