!!! DHQ CJD Reentry Form !!!

Thank you for taking the time to submit our Donor Reinstatement Form! The Blood Connection is excited to welcome you into our blood donor family. We will call you within 3 business days to finish the reinstatement process. Should you have any questions before then, please call 864-751-1154. Please do not try to donate blood until a member of our team calls you.

You should be taken to our home page website after submitting.

DHQ CJD Reentry Evaluation

First Name

Donor Last Name

Birthday

mm/dd/yyyy

Phone Number

(555) 555-5555 or 5555555555

Email

Donor ID

Home Address I

Suite / Appt

City

State

Zip Code

Comments (Optional)

Please check the box before trying to continue

Thank you for your submission! Please DO NOT try to donate until someone from TBC has contacted you. We are excited to have you in our TBC donor family!