top of page
MMBTN website Header (7).png

Prescreening Application

Your extra breast milk can help save lives. Thank you for your interest in becoming a milk donor.

​

Are you ready to take the next steps to becoming a donor? Please complete the prescreening application form below. Once you hit submit, you will be prompted to schedule your phone interview. 

0bb3d7_341b3f9a14994e11853bda65116685db~mv2_edited.png

IMPORTANT NOTICE

We are aware that some third-party companies offer financial incentives to milk donors, which place undue burden on milk bank donor screeners and milk processors. HMBANA member milk banks, like Mothers' Milk Bank of Tennessee, do not endorse or participate in these activities. We are grateful to our donors who choose to give their milk altruistically so that medically fragile babies have a fighting chance to grow and thrive! Milk donors are the superheroes who make nonprofit milk banking possible.

​

HMBANA member milk banks follow standards created by healthcare and regulatory experts, ensuring that all milk is donated freely and without financial compensation. This approach is backed by several organizations, including the World Health Organization, FDA, and CDC, who agree that voluntary donation is the safest and most ethical method.

Prescreening Application

Mothers’ Milk Bank of Tennessee is committed to protecting your privacy. We do not trade, share, or sell your information. 

 

Our donor screening program abides by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, which establishes national standards to protect individuals’ medical records and other health information that is individually identifiable. Click here to view our Privacy Policy.

Do you have 100 oz or more to donate?
Are you able to drop off your donations at a Milk Drop Depot if you are approved to donate? For a list of Depots visit https://www.milkbanktn.org/milkdropdepots
How did you hear about us?

PROSPECTIVE MILK DONOR AGREEMENT

I. I understand that if I am approved, that means my breast milk is approved to go through a pasteurization process to ensure its safety for medically fragile babies. My approval status as a donor is NOT an endorsement of my breast milk's quality. Therefore, I am prohibited from posting online that I am approved by Mothers' Milk Bank of Tennessee with the intent of promoting my donor status to sell my breast milk.

II. I understand that Mothers' Milk Bank of Tennessee does not compensate donors financially for breast milk. In addition, I  understand, Mothers' Milk Bank of Tennessee does not endorse or participate in activities from third party partners that offer financial offers for milk donors. 

HIPAA Consent for Communication via Text, Email, or Phone

Mothers' Milk Bank of Tennessee is committed to protecting your private health information under the Health Insurance Portability and Accountability Act (HIPAA). We understand that communicating via text message, email, or phone may be convenient, but these methods may not be secure. â€‹â€‹â€‹

I understand:

  • These communications may not be encrypted.

  • There is some risk of unintended disclosure.

I authorize, Mothers' Milk Bank of Tennessee, to contact me via the methods checked below regarding milk donation, scheduling, test results, or other relevant matters.
bottom of page