Donate Bone Marrow Full Application - Video

Bone marrow donors are urgently needed to help Lonza Donor Programs develop the medicines and treatments of tomorrow.

Donor Contact Information

Your contact information will be sent to Lonza Donor Programs staff who will be in touch with you to discuss questions and schedule an appointment within 72 hours of completing the form below. There are no obligations to filling out this form and all your information will be kept private.

"*" indicates required fields

Step 1 of 4

Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

I Have Previously Donated with Lonza*

When was your last donation?*

Are you under the care of a physician for any current or chronic illnesses?

Please explain physician care*

Are you taking any prescription medications?*

Please add medication and why you take medicine*

In the past 6 months, have you participated in any other donor programs such as blood or plasma donation, vaccine trials, or research studies?*

Please list the programs*

If female, are you currently pregnant or have you been pregnant in the past 12 weeks? Are you breastfeeding?

Please explain pregnancy status*

In the past 12 months, have you been hospitalized, had major surgery, or been in a mental health institution?*

Please explain hospitalization*

In the past 12 months, have you been incarcerated, detained, or been an inmate of a correctional institution, jail, juvenile detention facility, lockup, prison, or detention center for more than 72 hours?*

Please explain incarceration*

Do you have problems receiving injections with a needle or do you scar easily (keloid production)?*

Please explain injection issues*

Do you have a history of fainting or any negative reaction while giving blood?*

Please explain fainting or negative reaction*

Do you have a blood or bleeding disorder?*

Please explain blood disorder*

Do you have arthritis, bone, or joint disease?*

Please explain arthritis, bone, or joint disorder*

In the past 10 days, have you cared for, lived with, or otherwise had close contact with individuals diagnosed with or suspected of having COVID-19 infection?*

Last date of contact*

In the past 10 days, have you been diagnosed or suspected of having COVID-19 infection?*

Last date of potential infection*

In the past 10 days, have you had a positive test result from a COVID-19 test but never developed symptoms?*

Last date of positive result*

Will you be available to donate bone marrow within the next 6 weeks?*

Please explain availability*

Donate Today

Bone marrow donors are urgently needed to help Lonza Donor Programs develop the medicines and treatments of tomorrow.

Donor Contact Information

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