Vitalant Donor Forms | Blood Donation Resources & Documents

Notice of Privacy Practice

This information is relevant for individuals receiving Vitalant’s HIPAA covered healthcare services.

Notice of Privacy Practice (Spanish Version)

Reinstatement Form

Thank you for your interest in donating blood and helping to save lives! Please complete the following reinstatement form* if you were:

Previously deferred from giving blood by Vitalant (or one of our legacy blood centers),
or
Told by Vitalant you were ineligible due to a deferral that was applied to your donor record.

*You will be contacted via email or mail once your reinstatement has been completed. Due to the high volume of reinstatement requests, it could take up to 8 weeks before we are able to review and respond to your reinstatement request. Thank you for your patience.

Note: If you have never donated with Vitalant (or one of our legacy blood centers), please check our current donor eligibility information. Please do not complete the form below if you have not donated with Vitalant or one of our legacy blood centers.

You will be contacted via email or mail once your reinstatement has been completed.

Name*

Other Names

Email*

Phone*

Date of birth*

Donor ID

Zip Code*

List the state(s) where you previously donated. (If you haven’t donated with Vitalant or one of its legacy blood centers, put NA).*

City/State (where you want to donate blood now).*

Reason for your deferral (if unknown, enter 'Unsure').*

Download relevant forms for donation

Parent consent for minors

Privacy Practice

Deferred donor reinstatement

Notice of Privacy Practice

Reinstatement Form