Donation Screening

  • Thank you for donating to Children’s Hospital and Medical Center.

    One of our top priorities as an organization is to keep our patients, families and staff safe as well as members from the community.

    Please complete this form the day of your assigned donation.
    If this form is not completed we will not be able to receive your donation.

    Again thank you for your donation and for your part of keeping all involved safe.

  • If you have answered Yes to any of the below – We will have a staff member call you to do additional screening prior to your scheduled time of arrival.

  • MM slash DD slash YYYY


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