English
Odia
Rakta Bandhu
Enter your credentials to proceed.
Need Blood ?
Want to become a voluntary Donor ?
Full Name
*
Blood Group
*
Choose...
A+
B+
B-
O+
O-
AB+
AB-
No. of Units Required
*
Date of Requirement
*
Hospital Name
*
Hospital Address
*
Bed/Cabin Name
*
Doctor's Name
*
Photocopy of Requisition
*
Contact No. of Relative/Patient
*
Have You Contacted The Blood Bank?
*
Yes
No
Submit
Basic Details
Donor's Name
*
Date of Birth
*
Gender
*
Choose...
Male
Female
Mobile Number
*
Alternative Mobile Number
Email
Blood Group
*
Choose...
A+
B+
B-
O+
O-
AB+
AB-
Passport-size Photograph
*
History of Blood Donation?
*
Yes
No
Last Blood Donation Date
*
Present Address
District
*
Choose...
Block
*
Choose...
Village Name
*
Nearest Police Station
*
Post
*
Pin
*
Permanent Address
Same as Present Address
District
*
Choose...
Block
*
Choose...
Village Name
*
Nearest Police Station
*
Post
*
Pin
*
Register
Already registered ?
Login now