Questions


1. Are you aged between 17 and 65 years old?

Yes No

2. Do you weigh over 50kg (7st 12lbs)?

Yes No

3. Have you ever received a blood transfusion or blood products (whole blood, platelets or plasma) since 1st January 1980?

Yes No

4. Have you given blood in the past 12 weeks?

Yes No

5. Are you feeling fit and well and have you been well for the past 14 days?

Yes No

6. Have you been pregnant in the last 6 months or are you pregnant now?

Yes No

7. Have you ever been told that you should never give blood?

Yes No

8. Have you had any dental treatment in the past 7 days?

Yes No

9. Have you had any vaccinations or jabs in the last 8 weeks?

Yes No

10. Are you waiting to see a doctor, dentist, complimentary therapist or any type of health care person?

Yes No

11. Are you taking any medication prescribed by a doctor (except HRT, the pill or other birth control)?

Yes No

12. Have you ever had Cancer, Heart Condition, Stroke, Sexually Transmitted Diseases or Epilepsy?

Yes No

13. In the past 6 months, have you had an endoscopy (magic eye)?

Yes No

14. Have you ever had injections of growth hormones?

Yes No

15. In the past twelve months have you had a needlestick or other injury or accident that may have exposed you to infection?

Yes No

16. Have you ever had sex with anyone who has had sex in parts of the world where HIV / AIDS is very common (this includes most countries in Africa)?

Yes No

17. Have you taken ANY medicine in the last 7 days?

Yes No

18. Have you ever had hepatitis (viral Jaundice)?

Yes No

19. As far as you know, have you been in contact with anyone with an infectious disease in the last 4 weeks?

Yes No

20. Have you had acupuncture, ear piercing, body piercing, tattooing, cosmetic treatment or complimentary therapy that involved piercing the skin in the last 4 months?

Yes No

21. Has anyone in your family had CJD?

Yes No

22. Are you HIV positive or do you think you might be HIV positive?

Yes No

23. Have you had sex with anyone in the past twelve months who you know or think may have Hepatitis B or C or anyone who is HIV positive?

Yes No

24. In the last 12 months have you had oral or anal sex with another man with or without a condom or other form of protection?

Yes No

25. Have you ever lived or visited or had a blood transfusion in Central or South America?

Yes No
 

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