This donor has passed a rigorous medical examination to ensure absolute safety. Our screening process includes strict testing for infectious diseases (HIV, Hepatitis B/C, STIs), an evaluation of lifestyle habits, and a general physical assessment. We confirm the donor is currently in excellent health and free from transmissible conditions.
Assess your vision without corrective contact lenses
Do you wear contact lenses or have you had corrective surgery?
If yes, describe a problem:
What is the condition of your teeth?
Have you ever had braces?
Do you use nicotine products?
Do you drink alcoholic beverages?
If yes, how much alcohol do you drink?
Describe your diet
Estimate the level of nutrition:
Do you have allergies?
If yes, describe what exactly you are allergic to:
What is your sexual orientation?
How many children do you have?
Age at the time of the first menstruation:
The interval between menstruation is:
Have there been cases of multiple pregnancies in the family:
Please provide information about your biological relatives (indicate only natural hair and eye color):
Relative
Height, cm
Weight, kg
Eye color
Natural hair color
Primary medical history
Mother:
Father:
Complete the table
Family (which relative has the disease)
Age
Cause of death
Disease
The age at which was diagnosed
| Have you ever been diagnosed with or suspected of having any neurological disease (including dementia or degenerative /demyelinating disease of the CNS or other neurological disease of unknown etiology)? | No |
| Have you or any of your sexual partners ever been diagnosed with or suspected of having West Nile Virus (based on symptoms and/or laboratory results or confirmed WNV viremia), experienced symptoms of WNV infection? | No |
| Have you ever been exposed to known or suspected HIV, Hepatitis B, Hepatitis C infected blood or body fluids through skin inoculation, open wounds, non-intact skin or mucous membranes? | No |
| Have you or any of your sexual partners has had sex in the preceding 12 months with a person known to have HIV, clinically active HBV or clinically active HCV? | No |
| Have you or any of your sexual partner(s) ever received, blood, blood components, blood products, or other human tissues that are known to be possible sources of blood-borne pathogens? | No |
| Have you or your sexual partners been diagnosed with Zika virus in the past 6 months? | No |
| Have you travelled to an area with Zika virus transmission? | No |
| Alcoholism | No |
| Drug addiction | No |
| Alzheimer's disease / dementia before age 60 | No |
| Aneurysm | No |
| Fear / panic attacks | No |
| Attention deficit / hyperactivity disorder | No |
| Autism or Asperger's syndrome | No |
| Bipolar disorder | No |
| Blood coagulation disorders / hemophilia | No |
| Blindness before the age of 50 | No |
| Brain tumor / abnormality | No |
| Breast cancer | No |
| Cerebral palsy | No |
| Non-union of the lip or palate | No |
| Colorectal cancer | No |
| Flat feet | No |
| Depression | No |
| Epilepsy or seizures | No |
| Extra or fused fingers or toes | No |
| Genetic disorders | No |
| Hearing disorders / deafness under the age of 50 | No |
| Heart attack before age 50 | No |
| Heart defect | No |
| Huntington's disease | No |
| Immune disorders | No |
| Kidney defect / disorder / cancer | No |
| Intellectual disability / developmental delay | No |
| Melanoma | No |
| Mental retardation | No |
| Obsessive-compulsive disorder | No |
| Ovarian cancer | No |
| Pancreatic cancer | No |
| Parkinson's disease before the age of 60 | No |
| Pituitary disorder | No |
| Prostate cancer before the age of 50 | No |
| Schizophrenia | No |
| Speech disorders / lisping / stuttering | No |
| Split spine | No |
| Stroke under the age of 50 | No |
| Uterine cancer | No |
| Tourette syndrome | No |
| Vision disorders | No |
| Vitiligo / pigmentation disorders | No |
| Death before the age of 50, including childhood | No |
| Other cancer diagnoses before the age of 50 | No |
| Other congenital defects | No |
| Other health disorders | No |
| Diabetes | No |
| Hypertension | No |
| Rheumatoid arthritis | No |
| Pathology of the thyroid gland | No |
| Endometriosis | No |
“Big Five” personality traits of the Donor
1
Extraversion
2
Emotionality
3
Openness to New Experiences
4
Conscientiousness
5
Agreeableness
A
Psychological assessment of the donor:
The donor has a more pragmatic view of donation. She believes that this is a good way for each of the participants to get what they need. Some become parents, some receive financial support, etc. Therefore, she takes participation in the program seriously, conscientiously fulfills the necessary conditions, without unnecessary sentimentality.
She is married, has a 5-year-old daughter. Now her life and interests are mainly aimed at raising her daughter, her development, spending time together, etc. Her daughter is a cheerful, active, mobile child. She does gymnastics and dancing. She loves to sing, perform in front of an audience.
The donor's parents divorced when she was little, but her mother had a second marriage, so she has 3 younger brothers. They have a friendly, large, cheerful family. She maintained relations with her father, but he has already died, he was much older than her mother.
Her mother is a strong-willed, strong-minded and physically strong woman. If she wants something, she will achieve it. But she is a kind, sensitive, loving and caring mother.
For the donor, family is a talisman, it is stability, peace, reliability, warmth. Therefore, she considers her main achievement today to be her family. She saw an example of good family relationships in childhood, so she dreamed of creating a family. This is the main thing for her.
She was an active child. She was always interested in everyone and everywhere, asked questions, tried. She studied well, was fond of history. She loved to perform, easily memorized poems, stories. She attended various creative circles. She grew up in a village, so she spent most of her free time in nature, with active games, or helping her parents with the farm.
After the 9th grade, she went to work and entered college. Studying was fun and easy. A new company appeared, girlfriends, they studied together and spent their free time. She received a secondary specialized education - Confectioner.
Then she entered university to study tourism management, but when she got married and became pregnant, she decided to leave her studies for the time being. Maybe she will decide to resume her studies at university.
She considers her talent to be the ability to cook deliciously. This is her “element”. She likes to please her relatives with delicious food. Her husband jokes that she should open her own restaurant.
She dreams of her own house so that her child can run around in the yard, on the grass, and have a dog. She also dreams of traveling with her family.
Her relatives believe that she is the “soul of the company”, filling everyone with optimism and positivity when communicating. She is easy to get up and implement new ideas. It is never boring with her, but always interesting and active.
She considers herself kind, calm enough and gentle with her loved ones. She appreciates honesty and sincerity in people. Responsible, purposeful and hardworking.
