Blood Donation form – Bangoua 27/11/2021 Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *WhatsApp number *From which city are you? *What is your age? *Choose your gender *MaleFemaleDo not want to sayDo you agree to have the hospital give you a checkup? *YesNoHave you done a blood donation before? *YesNoChoose your blood group *O+O-B+B-A+A-AB+AB-I don't know my blood groupHave you had any disease? *YesNoDo you have any allergies? *YesNoComment or Message: Anything we should know? *Submit