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Test Form

Human Milk Bank Donor Screening Form

  • Select date DD slash MM slash YYYY
  • Lifestyle

  • (any alcohol consumed please wait 24 hours before commencing expressing donor milk) Acceptable alcohol limit, 1-2 units twice weekly however not at the same time
  • Caffeine limits are either a maximum of 2 cups of coffee or caffeinated drinks per day (approx. 230mls per 1 cup)
  • Baby

  • MM slash DD slash YYYY
  • Blood Consent

  • Collection consent required for compliance with the general data protection regulations

  • Improving Service