Live Donor Liver Transplant Downloadable Questionnaire

* Note: When faxing/sending questionnaire, please send proof of your blood type. If you need blood typing, please contact USC University Hospital for a special rate, (323) 442-5908.

Questionnaire in Acrobat (.pdf) format, instructions:

1. Download/view questionnaire by clicking here (file: live_donor_questionnaire.pdf, 83kb)
2. Print, then fill out by hand
3. Fax the completed questionnaire to: (323) 442-5721 - Attention: Live Donor Liver Transplant Coordinator

If you have trouble viewing, printing or saving, please contact us at (323) 442-5908.