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:
When the donor saw an advertisement on a social network and read information about the donation program, she became interested and realized that this is a good program that helps a woman become a mother and give the world a new life. She also decided to join this, because she has a physiological opportunity.
The donor grew up in a large family - she has 2 younger brothers and a sister. She is the oldest in the family, so she always helped her mother, was an authority, a role model for the younger ones. Her father died when she was 8 years old. She was raised most of her life by her stepfather. They have a friendly, strong and reliable family.
The donor's mother is kind, loving, but strict, fair, demanding, serious. She and her mother are more similar in appearance than in personal qualities. In this, she is more like her father - he was strong, strong-willed, persistent, sometimes even stubborn.
Donor was active, inquisitive, and mobile as a child. She wanted to grow up quickly and help her mother in everything. Her mother taught her everything she knew how to do – cook deliciously, take care of her loved ones, be hardworking, responsible, and persistent.
She studied well at school, and had a penchant for natural sciences and the humanities.
She took an active part in the life of the school – performances, concerts, organizing events. She was engaged in hand-to-hand combat, had good results, but after an injury, she had to leave this sport. She also did athletics, dancing, and cycling. Donor has been strong-willed since childhood, has a fighting spirit, and knows how to defend a sweet position.
After the 9th grade, she entered a vocational lyceum, where it was interesting – new acquaintances, friends, authoritative teachers, and practical classes. She studied excellently, especially appreciating the opportunity for practice.
Donor has a secondary specialized education in the specialty of a pastry chef. Now the donor is actively looking for a job.
She has a hobby – doing needlework. She also likes to spend time in nature, fishing, which helps her relax and regain strength after stressful situations.
She calls her speciality the ability to forgive and understand others. Even when someone offends her or does something bad to her, she cannot be offended for long or hold negative thoughts.
Her achievements to date are a graduation with honors from a vocational lyceum. She has several medals, distinctions and awards in sports and education.
The donor dreams of opening her own business, for example, a cafe or restaurant, and also dreams of living by the sea.
The donor is emotional, sensitive, sensual. If she has a goal, a plan, she brings what she has started to the end. In business, she is persistent, conscientious, responsible. The donor is a friendly, open, sociable person in communication. She has a sense of humor, strives to be in the circle of attention, needs to feel needed.
