Children's Hospital Colorado

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 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