Welcome to Physicians Plasma Alliance

Opening Hours : Monday to Friday 9am-5pm
  Contact : 1-877-637-5276

Pre-screening Form

Please fill out the pre-screening form below to determine your qualifications for PPA’s donor programs.

Click on the following list to indicate your diagnosis

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rightlogo1Donor Requirements

ok  You must be clinically diagnosed by a medical professional. Documentation of the diagnosis and/or treatment may be required.
ok  You must have a photo ID and be able to provide your social security number or proof of citizenship.
ok   You must be at least 18 years old.
ok   You must weight at least 110 lbs.
ok   You must disclose if you have ever been diagnosed with Hepatitis C and/or HIV.

Acute Specialty Antibodies List

Chagas DiseaseDengueGonorrhea/SyphilisHepatitis A/Hepatitis BHerpes Simplex Virus 1/Herpes Simplex Virus 2Lyme Disease/Barrelia burgdorferiMononucleosis/Epstein BarrToxoplasmosisVaricella zoster (Chicken Pox)Other (Describe in Message Box)

Chronic Specialty Antibodies List

AllergiesDiabetesMelanomaMultiple MyelomaOncologyRheumatoid ArthritisThyroid DiseaseOther (Describe in Message Box)

1. Are you currently being treated by a healthcare professional for this condition?

2. When were you diagnosed for this condition ?

3. Have you been prescribed any medication for this condition ?

4. If yes, describe your medications:

5. Are you experiencing any symptoms from your condition?

6. Have you recently had lab work to confirm your diagnosis?

7. If yes, please email to , fax to (423) 477-3164, or upload the file here:

Attached New

8. Have you ever been diagnosed with (check all that apply):

Contact Information

First Name:
Last Name: