If you are not sure of this, just enter '0000'
Ethnicity - please specify
Medication and supplements
Lifestyle* essential information for donor recruitment
Please note: the maximum alcohol intake for breast milk donors is 1 to 2 units once a week. A unit is a small glass of wine, 1/2 pint of normal strength beer or a single pub measure of spirits. Please leave 12 hours after drinking any alcohol before expressing milk for donation to the milk bank.
About your baby
If yes, please provide their names, date of birth and if they were breastfed below:
Donating breast milk
Please note that if your milk is stored at a hospital you would need to complete and submit a ‘Donor milk release form’ in order to release your milk to us – we will send the documentation to you if applicable.
Please note that your breast milk must be stored at -18 ◦C or cooler (-19◦C ; -20◦C , -21◦C ; -22◦C etc.). We will provide a thermometer in the Donor Pack following registration.
Please note we cannot accept milk collected using the drip method e.g. Haakaa pump or shells.
Please specify, for example hand wash, air dry and steam sterilise: (Please note we cannot accept Milton tablets as a form of sterilisation).
During the last 14 days, have you or any member of your household: