Repeat Donations - Lonza Donor Programs

Please submit the form below and we’ll reach out with available donation times.

Your donation will take place at our Rockville, Maryland facility.

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.

For a refresher on the donation process, we encourage you to watch this video.

"*" 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 medical conditions?

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 sex at birth, 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 an inmate of a correctional institution for more than 72 hours?*

Please explain incarceration*

Do you have problems receiving injections with a needle or have you fainted in the past due to receiving an injection?*

Please explain injection issues*

Do you scar easily? (keloid production)*

Please explain scarring issues*

Does the thought of giving blood cause you to feel anxious or unwell?*

Please explain you anxious or unwell feelings*

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 any arthritis, bone, or joint conditions?*

Please explain arthritis, bone, or joint disorder*

Do you currently have or a history of any back, hip, or spine conditions or issues?*

Please explain your back, hip, or spine conditions or issues*

In the past 10 days, have you recently had symptoms of COVID-19, tested positive for COVID-19, or have you been around anyone who has tested positive?*

Last date of contact, potential infection, or positive result*

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

Please explain availability*

Donate Today!

Please submit the form below and we’ll reach out with available donation times.

Your donation will take place at our Rockville, Maryland facility.