Complete the coronacheck

Coronacheck

Have you been advised to stay in home quarantine for the time being? (e.g. because you are awaiting an examination/result or have visited an area with a code orange travel advice)
Unfortunately, you may not attend to donate right now.

You have informed us that you have been advised to remain in home quarantine for the time being, which is why we are postponing your donation.

Fill in your details below. We will contact you for a new appointment or ask you to attend when your blood is needed.
Yes
No

Have you had one or more of these complaints now or in the past 14 days:
- Cough
- Sore throat
- Nose cold, runny nose, sneezing
- Increase in temperature or fever
- Shortness of breath
- (Recently experienced) loss of smell and/or taste
Unfortunately, you may not attend to donate right now.

You have informed us that you are displaying one or more symptoms that may indicate COVID-19, which is why we are postponing your donation.

Fill in your details below. We will contact you for a new appointment or ask you to attend when your blood is needed.
Yes
No

Do you currently have, or have you had in the past 14 days, a roommate/family member with a cold and/or shortness of breath in combination with fever?
Unfortunately, you may not attend to donate right now.

You have informed us that a housemate or family member is displaying one or more symptoms that may indicate COVID-19, which is why we are postponing your donation.

Fill in your details below. We will contact you for a new appointment or ask you to attend when your blood is needed.
Yes
We’re looking forward to seeing you at the blood bank!

Fill in your details below, so we can send you the confirmation to your email address. Show this at the reception desk of your blood bank. Are you unable to show this confirmation on your phone? Then please use the flyer at the blood bank. Don't forget to do the donation check as well, so you can be sure that you are allowed to donate.
No

Donor ID

These are the numbers under the largest barcode on your donor card.

Initials

Last name (as it appears in your passport)

By this we mean your name as stated in your passport, identity card or driving license.

Date of birth*

E-mail address

I agree with the terms and conditions *

I have checked my data for accuracy*

Donor ID

These are the numbers under the largest barcode on your donor card.

Initials

Last name (as it appears in your passport)

By this we mean your name as stated in your passport, identity card or driving license.

Date of birth*

E-mail address

I agree with the terms and conditions *

I have checked my data for accuracy*

Did you register before?

Gender

Male

Female

Initials

Last name (as it appears in your passport)

By this we mean your name as stated in your passport, identity card or driving license.

Date of birth*

You can only apply between your eighteenth and sixty-fifth birthdate

Street

House number

Postal code

City

Phone number

E-mail address

Select the location where you want to donate blood. Not sure which location is nearby? Information about locations, see Contact.

Plan your first appointment at the blood bank During this first appointment you will have a meeting with our donor doctor, we will collect a few tubes of blood from you for testing and we will ask you about your medical history.
The appointment will last approximately 60 minutes.

Sorry, we cannot connect to the online agenda. Try to complete your application at a later time.

Date

Available dates

Selected date

Select the time when you want to visit us.

Check date and time
-
Time - hour
-

I agree with the terms and conditions *

I have checked my data for accuracy*

Did you register before?

Gender

Male

Female

Initials

Last name (as it appears in your passport)

By this we mean your name as stated in your passport, identity card or driving license.

Date of birth*

You can only apply between your eighteenth and sixty-fifth birthdate

Street

House number

Postal code

City

Phone number

E-mail address

Select the location where you want to donate blood. Not sure which location is nearby? Information about locations, see Contact.

Sorry, we cannot connect to the online agenda. Try to complete your application at a later time.

Date

Available dates

Selected date

Select the time when you want to visit us.

Check date and time
-
Time - hour
-

I agree with the terms and conditions *

I have checked my data for accuracy*

Gender*

Male
Female

Initials*

Date of birth*

Street*

House number*

Postal code*

City*

Phone number*

E-mail address*

Sorry, we cannot connect to the online agenda. Try to complete your application at a later time.

Date

Available dates

Selected date

Available times

Select the time when you want to visit us.

Check date and time
-
Time - hour
-

I agree with the terms and conditions *

I have checked my data for accuracy*

Last name (as it appears in your passport)*

By this we mean your name as stated in your passport, identity card or driving license.

Date of birth*

You can only apply between your eighteenth and sixty-fifth birthdate

Phone number*

E-mail address*

Last name (as it appears in your passport)*

By this we mean your name as stated in your passport, identity card or driving license.

Date of birth*

You can only apply between your eighteenth and sixty-fifth birthdate

Phone number*

E-mail address*

Donor ID

Last name (as it appears in your passport)

By this we mean your name as stated in your passport, identity card or driving license.

Date of birth*

Postal code

House number

E-mail address

I have read the questions in the coronacheck and I have answered the questions truthfully.*

E-mail address

I have read the questions in the coronacheck and I have answered the questions truthfully. *

Gender*

Male
Female

Initials*

Date of birth*

Street*

House number*

Postal code*

City*

Phone number*

E-mail address*

Sorry, we cannot connect to the online agenda. Try to complete your application at a later time.

Date

Available dates

Selected date

Available times

Select the time when you want to visit us.

Check date and time
-
Time - hour
-

I agree with the terms and conditions *

I have checked my data for accuracy*

Coronacheck question 1

Coronacheck question 2

Coronacheck question 3

Have you been advised to stay in home quarantine for the time being? (e.g. because you are awaiting an examination/result or have visited an area with a code orange travel advice)

Unfortunately, you may not attend to donate right now.

Have you had one or more of these complaints now or in the past 14 days:

Cough

Sore throat

Nose cold, runny nose, sneezing

Increase in temperature or fever

Shortness of breath

(Recently experienced) loss of smell and/or taste

Unfortunately, you may not attend to donate right now.

Do you currently have, or have you had in the past 14 days, a roommate/family member with a cold and/or shortness of breath in combination with fever?

Unfortunately, you may not attend to donate right now.

We’re looking forward to seeing you at the blood bank!

Resultaat

Coronacheck question 1

Coronacheck question 2

Coronacheck question 3

Have you been advised to stay in home quarantine for the time being? (e.g. because you are awaiting an examination/result or have visited an area with a code orange travel advice)

Unfortunately, you may not attend to donate right now.

Have you had one or more of these complaints now or in the past 14 days: Cough Sore throat Nose cold, runny nose, sneezing Increase in temperature or fever Shortness of breath (Recently experienced) loss of smell and/or taste

Unfortunately, you may not attend to donate right now.

Do you currently have, or have you had in the past 14 days, a roommate/family member with a cold and/or shortness of breath in combination with fever?

Unfortunately, you may not attend to donate right now.

We’re looking forward to seeing you at the blood bank!

Resultaat

Have you had one or more of these complaints now or in the past 14 days:

Cough

Sore throat

Nose cold, runny nose, sneezing

Increase in temperature or fever

Shortness of breath

(Recently experienced) loss of smell and/or taste