Public Health Platform

Campaign Registration Form

1
Account Information
Name, Mobile Number and Email ID
2
Personal Details
Gender, Date of Birth, Blood Group & Address
3
COVID History
Past medical history of COVID
4
Completion
Provide your Consent and Submit

Mission COPE (COVID Plasma Endeavour)

Plasma Donation Pledge - Covid India Campaign

The information provided here in this Donation Pledge Form will be subjected to verification before one can donate their Plasma. Kindly keep the COVID Medical records ready for verification purposes.
Account Information
Please provide the below information to Register yourself
Personal Details
Please provide your personal details
COVID History
Please provide your History on COVID
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Completion
Please provide your consent to share your information and Submit to Complete
The information provided by you will is accessible by the below Organizations
The information provided by you shall be solely used for the purpose for which this form is being submitted.
HCG Cancer Care Center Hospital HCG Tower, # 8, P. Kalinga Rao Road, Bengaluru, Karnataka - 560027
SyMetric Service Provider No. 19, CA Site No. 1, HAL 3rd Stage, Bengaluru, Karnataka - 560008
HCG Cancer Care Center Hospital HCG Tower, # 8, P. Kalinga Rao Road, Bengaluru, Karnataka - 560027