Gulf Coast Blood - Donor Portal

1. Let us know where you would like to contribute, and we will share more when the opportunity arises. *

Cancer

Metabolic Health

Mental Health

Alzheimer's Disease

Sick Cell Disease

Vaccines

Cardiovascular Health

Infectious Diseases

Respiratory Diseases

Gastroenterology

Dermatology

Rheumatology

Regenerative Medicine

Autoimmune Disorders

2. Which of the following best describes your use of tobacco or nicotine products? *

Select all that apply

I have never regularly used tobacco or nicotine products

I currently smoke cigarettes

I previously smoked cigarettes

I currently use e-cigarettes or vaping products

I previously used e-cigarettes or vaping products

I currently use cigars, pipes or smokeless tobacco

I previously used cigars, pipes or smokeless tobacco

Prefer not to answer

3. During the past 12 months, how often have you consumed an alcoholic beverage? *

Never

Less than once a month

1–3 times per month

1–2 times per week

3–4 times per week

5 or more times per week

Prefer not to answer

4. Have you ever used a GLP-1 or related medication? *

Examples include semaglutide, tirzepatide, liraglutide and dulaglutide.

Currently using

Previously used

Never used

Prefer not to answer

5. Which vaccinations have you received, if known? *

Select all that apply:

6. Have you previously received HLA or KIR testing? *

Yes, HLA testing

Yes, KIR testing

No, HLA testing

No, KIR testing

Prefer not to answer

7. Has a healthcare professional ever diagnosed you with any of the following conditions? *

Select all that apply:

8. Have you ever been diagnosed with cancer by a healthcare professional? *

If so, please select the type or types below.

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