Your Email ID
Your Mobile No.
Did you ever test +ve for Covid -19 Infection?
Date of testing positive for Covid-19
What was your date of recovery?
Did you ever Donate plasma before if yes when?
Your Blood group ?
Do you suffer from any of the following diseases?
DiabetesBlood PressureLiver DiseaseLung DiseaseOtherNA
Do you consume Alcohol?
Do you have an aadhar card ?
Do you have discharge report issued by the hospital where you were treated ?
Do you have any message for Us?