Children's Hospital Colorado

Physician Referral for Autologous Blood Donations

A woman helps a patient girl at Children's Hospital Colorado.

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 Please contact the Blood Donor Center with any questions.

Referral for Autologous Donation (.pdf)

Contact Info

Blood Donor Center
Phone: 720-777-5398
Fax: 720-777-7255