Physician Information

Physician Request Form for Therapeutic Donation

Physician Request Form for Autologous/Directed Donation

Specialized Donations - Therapeutic, Autologous and Directed Donations

General Information

• Autologous, directed and therapeutic donation appointments for conditions including polycythemia and erythrocytosis, may not be scheduled online. Patients must call Specialized Donations Scheduling at 303.363.2330 or 800.421.9529 Monday through Friday from 8 a.m. to 4 p.m. to schedule a donation appointment or email SDS@bonfils.org.
• Autologous and Directed donations are offered at our Specialized Donations Donor Center in Lowry, Pueblo and Sterling by appointment only.
• Therapeutic donations are offered at nine Community Donor Centers by appointment only.
• A valid prescription is required to schedule an appointment.

Therapeutic Requirements

• A prescription must include patient demographic information, diagnosis, donation frequency and minimum pre-draw hematocrit.  Physician Request Form for Therapeutic Donation
• For Hereditary Hemochromatosis patients, your blood may be used for the community blood supply. Please complete the Statement of Understanding.
• A valid prescription is required to schedule an appointment.  

Autologous and Directed Donation Requirements

• A prescription must include patient demographic information, surgery date, location and number of units requested.  Physician Request Form for Autologous/Directed Donation
• Please note all units must be collected a minimum of 7 days prior to surgery.  We recommend patients call to schedule an appointment at least 10 days prior to surgery.
• For additional information, please review the Physician Information for Autologous/Directed Blood Donation.