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Register to donate milk form

Registering to donate milk starts with two important steps.

First of all the registration and screening form, will be reviewed according to our criteria for donating milk.

Second, we will need your blood test results for a few important screens. The list of required tests are: 

  • HIV
  • Hep B & Hep C
  • Syphilis
  • HTLV 1 & 2
  • CMV
View all 6 steps
Step 1
Register

Please fill out the Donor Registration and Screening Consent form below and submit.

You will be emailed with more detailed information once this form is submitted.

Step 2
Screening blood tests

We require blood tests to be performed. Please call your GP to request a Pathology Referral form asking for the specific tests to be conducted.

Donor Eligibility Questions

Actual Donor Registration Form

Primary Eligibility Question

Thank you for your interest in donating your breast milk. There are a few questions we need to ask first.

Please read over the following statements and then select the below option that applies to you.

  • I drink more than 2 standard alcoholic drinks per day.
  • I consume more than 750mls of caffeinated or stimulant drinks daily.
  • I eat a lot of chocolate or stimulant foods daily.
  • I smoke, vape or use nicotine patches and/or gum.
  • I have used recreational drugs in the last 12 months.

Unfortunately, we cannot accept your donor breast milk as you have selected one or more ineligibility criteria. Your milk will not be suitable for infant consumption, but it can still be used for research purposes. If you would like more information on how you can donate your milk for research, please email us, and our team will contact you.

Please note:

If you have or had a recent breast or nipple infection, or any infection, you MUST wait 7 days after finishing the last dose of medication or treatment before expressing and collecting your milk for Mothers Milk Bank Charity.

You must wait 7 days following a reactivation of a latent infection with Herpes Simplex Virus (Cold Sore) or Varicella Zoster (Shingles) of the breast or chest starting from when the lesions crust over before expressing and collecting your milk for Mothers Milk Bank Charity.

Contact Details

Donor Information

Health Details

Final Questions

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Register to Donate Milk form

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