UC Irvine Medical Center Donor Center Appointment Request Form

Thank you for your interest in donating blood or platelets at the Blood Donor Center at UC Irvine Medical Center. We are located in Pavilion 3 at the medical center in Orange.

Please complete the online form below to make an appointment to donate blood or platelets. If you are donating for your own surgery, or donating for a friend or relative, a doctor's order is required. Please do not make your appointment online; call us directly to make an appointment at 714.456.5733. If you have never donated platelets before, please read about the donation process first to make sure you understand the procedure and the time commitment. View more information on who can donate »

If you have any questions or would prefer to make your appointment over the phone, please contact us at 714.456.5064 or donateblood@uci.edu

 
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CURRENT HOURS
    
Day   Open
Monday    7:00am-5:30pm
Saturday    Platelets only- 7am-12:30pm (by appointment only)
 
YOUR INFORMATION  - PLEASE ENTER YOUR LEGAL NAME
     First Name:*        Nick Name:  
Middle Name / Middle Initial:
Last Name:*
Date of Birth:* Format: (mm/dd/yyyy)
Suffix:
Gender:*
Email:*
Confirm Email:*
Preferred Phone:*
Phone:*
 
APPOINTMENT INFORMATION
Organization or Club:
Blood Type:
Appointment Type:*
Appointment Date:* Format: (mm/dd/yyyy)
Appointment Time:*