Blood and Platelet Center Appointment Request - UCLA Health

Thank you for your interest in donating blood or platelets!

Please fill out the form below and one of our staff will contact you to make an appointment. You can also call our office at (310) 825-0888 ext. 2 to donate blood or platelets.

Have You Ever Donated Blood for the UCLA Blood & Platelet Center? *

Yes

First Name *

Last Name *

Date of Birth *

MM/DD/YYYY

Gender *

I Want to Donate *

Email Address *

Address

City

State or Province

Zip or Postal Code

Phone Number *

Best Time to Call

Preferred Dates and Times

Preferred Location *

Gayley Avenue

Ackerman Union

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