Donor Screening Assessment Introduction

Thank you for your interest in becoming a milk donor to PREM Bank. To ensure donated milk is safe we ask all donors questions relating to health and lifestyle, similar to blood donor screening. Please be accurate and honest; if you do not register or complete the assessment, no information is stored. If you do register, your information remains strictly confidential.

This is a preliminary screening only. There are three steps.

Have you ever:
Been declined as a blood donor for a medical reason (other than pregnancy and nursing)?
*
Tested positive for HIV, Hepatitis, TB or have a history of cancer?
*
Injected drugs not prescribed by a doctor or had a sexual partner who has?
*
Lived in or travelled to the UK between 1980-1996 for six months or more?
*
Do you currently:
Smoke or use tobacco products (including nicotine patches or gum)?
*
Regularly consume more than two standard alcoholic drinks per day?
*
Regularly consume more than 750ml (3 cups) of tea, coffee, cola or stimulant soft drinks per day?
*
In the last twelve months have you:
Had close contact (cohabitation or intimate contact) with someone with hepatitis, or someone at risk of AIDS, HIV (including haemophiliacs and IV drug users)?
*
Had ear or body piercing?
*
Had a tattoo or permanent make up?
*
Had an accidental needle stick injury?
*
Had accupuncture or electrolysis?
*
Received a blood transfusion, blood products including Anti D or any other immunisation?
*
Do you currently have:
An infection of the breast, such as mastitis or thrush?
*
A cold sore (herpes simplex virus)?
*
Have you or a family member recently been exposed to chicken pox or shingles?
*
Are you currently ill and taking regular medication?
*
Registration
*
*
Baby's date of birth?
Baby's due date?
Please select one: