Join the Stem cell donor Registry

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Registration form
*Required fields

Medical questionnaire

*Are you between the ages of 18 and 35?
*Date of birth:
*Are you in good health?
*Please indicate your height and weight.
*Have you given blood before?
If so, in which year and city did you last give blood?
*Has Héma-Québec, the Canadian Blood Services or a physician ever told you NOT to give blood?
If so, why?

*Have you ever had one of the following conditions:

Cancer, not including successfully treated skin or cervical carcinoma
Insulin-dependent diabetes mellitus
Heart disease or heart surgery or heart valve transplant
Chronic lung diseases or asthma treated with steroids or causing an anaphylactic reaction
Ulcerative colitis (disregard non-ulcerative colitis)
Crohn's disease
Epilepsy requiring medication and/or seizure in the past 2 years
Rheumatoid arthritis
Ankylosing spondylitis
Neurological problems
Schizophrenia or bipolar disease
Anemia with continuing iron prescription or severe symptoms
Sickle-cell, aplastic or hemolytic anemia of genetic origin
Hepatitis B or C/positive test result for hepatitis or HIV
Creutzfeldt-Jakob in a close relative