Donate Milk Registration Form
Registering to become a Donor Mother is a 3 STEP process.
Please fill out the Registration form below and
Fill out and sign our Donor Mother Screening Consent Form and Donor Mother Preliminary Oral Screening Questions on the next page and
To donate we need your donor screened blood results.
Please call your GP to order the blood test, they will bulk bill. Ask your GP for the blood test needed to donate & to give you a copy of the results.
You will be emailed with more detailed information once STEP 1 and 2 are submitted.
Thank you for undertaking the Donor Mother Registration Process.
Please answer all applicable questions truthfully and to the best of your ability.
OPTION 1: For mothers who are currently breastfeeding
OPTION 2: For expecting mothers who wish to breastfeed their own child and also contribute, if possible, to the Mothers’ Milk Bank.
Please note: If you have chosen OPTION 2 and are successful in your Donor Mother Registration, a Mothers’ Milk Bank consultant will contact you one month after your baby’s birth to see how you are progressing and whether you still wish to donate to the Mothers’ Milk Bank. At this time, you may also have stored breastmilk available that you would like to contribute as a one-off donation. When indicating your intent to donate and submitting this registration, the will be no obligation for you to contribute to the Mothers’ Milk Bank if you are unable or unwilling to do so at that time.
CURRENTLY NOT AVAILABLE
(ie. illness, disease, having lived in the United Kingdom between the years 1982-1995)
(ie. smoker, drug user, consume large quantities of cafﬁnated/stimulant beverages, recent blood transfusion)
hereby certify that, to the best of my knowledge,
all of the information I have provided is correct and I have answered all questions truthfully.
Please sign the form
The following section is optional, but we would really appreciate your assistance and consideration in taking the time to answer these additional questions.
You will be emailed a copy of this form.