Recovered COVID-19 Patient
Prospective Donor Submission Form
PlasmaLab International | Everett WA

First Name
Last name
Birth Year
City you live in
State/Province you live in
ZIP code

Was your COVID-19 diagnosis confirmed by a lab test?


Do you have a copy of your COVID-19 test results for us to review?


Do we have your permission to ask the healthcare authorities or your medical provider for information about your COVID-19 testing?


Are you currently experiencing symptoms from COVID-19?


Are you currently donating plasma for another program?


Are you willing to provide multiple blood samples over several weeks and potentially donate plasma one or more times if accepted into PlasmaLab's COVID-19 Research Program? (Please note: weekday appointments only.)


Terms and Conditions Agreement

PlasmaLab will contact you with details about our antibody research program(s). PlasmaLab will make every effort to safeguard your information and will not share, sell, or allow access to this information with anyone.

The blood sample for the COVID-19 screening is uncompensated. Upon acceptance into the COVID-19 program, donor compensation will be issued upon qualification, acceptance, and completion of one blood draw and/or plasma donation for our COVID-19 plasma research program. We may also request additional blood samples and/or plasma donations. To learn more about our donor qualifications for the COVID-19 program, please click here.

Our complete list of conditions may be accessed in our Privacy Policy