Vitalant - Reinstate

Thank you for your interest in donating blood and helping to save lives! Please complete the following reinstatement form* if you were:

previously deferred from giving blood by Vitalant (or one of our legacy blood centers),
or
told by Vitalant you were ineligible due to a deferral that was applied to your donor record.

*You will be contacted via email or mail once your reinstatement has been completed. Due to the high volume of reinstatement requests, it could take 3-4 months before we are able to review and respond to your reinstatement request. Thank you for your patience.

Note: If you have never donated with Vitalant (or one of our legacy blood centers), please check our current donor eligibility information, then . Please do not complete the form below if you have not donated with Vitalant or one of our legacy blood centers.

You will be contacted via email or mail once your reinstatement has been completed.

Full Name

List any other names you may have used during previous blood donations (or attempts to donate) with Vitalant, or any of its legacy blood centers, such as: nicknames, maiden names, prior married names, etc. (Optional)

Date of Birth

Email Address (put N/A if you don't have an email address)

Phone Number

( ) -

Zip Code

List the state(s) where you previously donated. (If you haven’t donated with Vitalant or one of its legacy blood centers, put NA).

City/State (where you want to donate blood now)

Reason for your deferral (if unknown, enter 'Unsure')

Donor ID # (if known) (Optional)

Reinstatement Request