COVID-19 Convalescent Plasma Expanded Access Program

Please complete the form below if you are interested in donating plasma for a clinical trial here at Roswell Park. If you are found to meet the initial criteria, your information will be forwarded to our Donor Center to follow up with you directly.

You may also call 1-800-ROSWELL (1-800-767-9355) to schedule an appointment.

Your Information

Are you the patient? *

Are youIs the patient currently a Roswell Park patient?

Your Patient's Contact information

Best method to contact?

Donation Status Details

Are you at least 110 pounds (50 kg)? *

Have you donated blood within the past 56 days? *

Are you currently experiencing any active cold or flu symptoms, headaches, cold sores, or infections? *

Have you had a positive test for COVID-19, and are you able to provide the date and verification of this test? *

How long have you been asymptomatic for? *

Can you provide us with verification of a negative follow-up COVID-19 test?