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 believes that donation is a good cause in which she can participate and also make her contribution, so that another family has the opportunity to have children, so that another couple becomes parents. It is also an additional opportunity to undergo a full comprehensive examination.
The donor is divorced, raising a 6-year-old son. Who draws well, sings, is a creative child. He is active, charismatic, strong-willed and persistent in his thoughts and positions.
She has a large, noisy, cheerful family. She has 3 brothers and a one-year-old half-brother. Her parents are divorced, they already have new families. But they are all close, have good relationships, stick together.
Her mother is a “fire woman” - strong-willed, controlling everything, the soul of the company, emotional, characteristic.
Her father is quiet, calm, caring, kind, generous.
She had a close and warm relationship with her grandmother. Grandma loved her very much, called her “Elena the Beautiful”, “Golden Child”. They spent time together, talking, grandma taught her interesting things. She was a creative child – she drew, played sports, danced. She studied at an art school. She studied well, at school everything that needed to be drawn, designed, or performances, competitions – she did it all first. As long as she can remember, she has always drawn.
They had a big family, always noisy, fun. Dad and mom had 4 brothers and sisters, all the children, when they got together, it was very magical. She was friends with her cousin, studied in the same class. She traveled to many cities in Ukraine with her dad. Her childhood was interesting, fun, lots of funny stories and memories. As a child, she dreamed of becoming an archaeologist.
She believes that family is the most important aspect of life. Sometimes she misses her childhood family, its unity.
After 11th grade, she worked as an engraver. Then she studied to be a tattoo artist and has been doing this for 8 years. She draws very well, so it was her artistic talent that became her life's work.
At 19, she gave birth to a son and considers it one of her achievements. She also considers her independence from other people's opinions to be an achievement.
She dreams of learning to drive a car, buying a car and her own house.
Her brother says that she never has a "black streak". She is an optimist in life, positive, open, sociable. She is a strong person, strong-willed, knows how to cope with difficulties. Cheerful, kind, smiling.
Friendship is important to her, she needs communication, closeness, joint walks, time with friends.
Donor is sweet, pleasant to communicate with, talkative, charming. She has a good sense of humor, a positive outlook, optimistic. She is creative, talented, develops her skills. Responsible, punctual, purposeful and ambitious.
