Donor Screening Form

Name

This field is for validation purposes and should be left unchanged.

Please review the following safety criteria for milk donation.

Do you regularly take prescription medications for long periods of time?
- It is generally acceptable to take progestin-only birth control pills, thyroid replacement hormones, insulin, nasal sprays, skin creams or ointments, eye drops, prenatal vitamins and regular-dose supplements.
Are you or your partner at risk for HIV?
Have you tested positive for HIV (human immunodeficiency virus), HTLV (human T-lymphotropic virus), hepatitis B, hepatitis C or syphilis?
Have you used illegal drugs by injection?

Have you answered yes to any of the questions above?

Yes

No

Thank you for your interest in donating. Unfortunately, we cannot accept donors who do not meet the safety criteria. If you have special circumstances, please contact us at info.milkbank@sinaihealth.ca or 416-586-4800 ext. 6246. To support the Milk Bank in other ways, please consider making a financial gift External Link or helping us spread the word. We are grateful for your support.

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Please review the following general health and donation requirements for milk donation.

Are you in good general health and nursing a baby who is under 18 months of age?
- Bereaved donors or those who have experienced a late miscarriage or stillbirth, who meet eligibility and choose to pump milk in honour of their baby, are accepted.
Are you free from smoking, illegal drug use and regular alcohol use?
Are you able to have your health-care provider complete medical history forms on your behalf?

Do you meet all the criteria listed above?

Yes

No

Thank you for your interest in donating. Unfortunately, we cannot accept donors who do not meet the current health and donation requirements. To support the Milk Bank in other ways, please consider making a financial gift External Link or helping us spread the word. We are grateful for your support.

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Have you reviewed the Collecting, Storing and Transporting Human Milk guidelines, and can you confirm that you can commit to the following:

Pumping at least five to 10 litres (about 165 to 330 ounces) of milk over two months?

Do you meet the criteria listed above?

Yes

No

Thank you for your interest in donating. If you are unable to commit at this time, we invite you to support the Milk Bank in other ways. Please consider making a financial gift External Link or helping us spread the word. We are grateful for your support. If you have any questions, please contact us at info.milkbank@sinaihealth.ca or 416-586-4800 ext. 6246.

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Become a donor

Eligibility assessment

Donor screening form