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We’re here to support you every step of the way

Thank you for your interest in providing lifesaving human milk for babies in need. When a mother cannot provide her own milk for her baby, donor milk gives babies the best chance of surviving and thriving.

Please complete step one of the process by submitting the donor screening form below. If you’re looking for more information about the donor process, check out how it works or visit our FAQ section to get your questions answered.

Donor Screening

Date*
First Name*
Last Name*
Street Address*
City*
State*
Zip Code*
Phone*
Email*

How did you hear about Mothers’ Milk Bank?
Please be specific so we can thank our community partners.

Baby's Name*

Baby's Date of Birth*

Was the baby born full term? YesNo

If no, how many weeks preterm

Is your baby in the hospital? YesNo

If yes, Name of hospital and contact information

Bereaved donor? YesNo

Surrogate donor? YesNo

Are you a previous donor? YesNo

How many ounces do you currently have stored in your freezer that you would like to donate?

Approximate oldest date of milk*

Was the expressed milk stored in the freezer? YesNo

Was the milk in the refrigerator more than 96 hours (4 days) before moving it to the freezer?
YesNo

Has your milk been thawed, scalded or boiled? YesNo

If yes, please explain:

Are you a Kaiser Permanente patient? YesNo

I understand Mothers’ Milk Bank is a nonprofit organization and I will not receive financial compensation for my milk donation