Physician Referral for Autologous Blood Donations

Autologous blood donations are provided by patients for their own use later during surgery or other medical procedures. The Blood Donor Center must have a referral form on file to perform autologous donations for a specific patient.

The form is to be completed by the physician and faxed to the Blood Donor Center at (720) 777-7255. You may also e-mail the form to Donate4Kids@childrenscolorado.org. Please contact the Blood Donor Center with any questions.

Referral for Autologous Donation (.pdf)