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Milk Bank Donor Screening

The survey will take approximately 7 minutes to complete.

Pasteurized Donor Milk is lifesaving and provides the best nutrition possible for a baby when their own mother's milk isn't an option. Thank you for your interest in joining our lifesaving mission!

The milk we distribute is provided to babies who may be medically fragile. For this reason, milk donors must meet safety requirements. Donors must be in good health, not currently using tobacco products, CBD oil, marijuana or illicit drugs and at low risk for communicable diseases like HIV and hepatitis.

This form is the first step to determine donor eligibility. After you've submitted the form, a Milk Bank staff member will contact you to help with the next steps.

*Asterisk indicates required field.

Are you donating milk that was collected before you filled out this form?
Approximately how much milk do you plan to donate?
Are you willing to have your blood drawn to test for diseases like HIV and Hepatitis? There is no cost to you for these tests.
In the last 12 months, have you smoked or used tobacco products, e-cigarettes, vapes, hookahs, or used a nicotine patch or nicotine gum?
In the past 12 months have you vaped, smoked, eaten, or put on your body (topicals) products that have cannabis (marijuana)?
Have you taken any medicines including prescriptions, over the counter medications, vitamins, botanical dietary supplements (herbal products), or vaccines while pumping or in the 2 months prior to pumping?

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