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Health History Questionnaire

When it comes to transforming lives, every moment matters. You can save time, up to 20 minutes, while saving lives by filling out your Vitalant health questionnaire online the day of your donation.

Important tips for filling out your Vitalant Health History questionnaire online:  

  • The Vitalant health questionnaire must be filled out on the same day as your appointment, starting at 12:01 a.m. 
  • The questionnaires are different depending on your location. Be sure to click on the version for the state where you are donating. The states are pictured and listed below. 
  • Carefully follow the instructions at the end of each health questionnaire for printing your ticket/pass or saving it to your mobile device. You will need to show the ticket to Vitalant staff at your donation.   
  • If any of the above steps were not followed, you will have to answer the questions again at your appointment. 

To access the online health history questionnaire for your donation location, be sure to click on the appropriate link below for your state:


Fast Track

Alabama, Arizona, Arkansas, California, Colorado, Idaho, Illinois, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nevada, New Mexico, North Dakota, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, Washington, West Virginia, Wyoming


bexWise Xpress

New Jersey