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 saw an advertisement for the program on social networks. She became interested and decided to find out more information, to make sure that it was safe for her health. After hesitation, she decided to try to become a donor. She knows that there are enough women in the world who would like to become a mother, but cannot for certain reasons. Therefore, she is happy to be useful to someone, to help, to do a good deed.
The donor is married, has a good, trusting and reliable relationship with her husband. She has a 2-year-old daughter. Who is a healthy, active, mobile child. She attends kindergarten, inquisitive, sociable. Still small, but already smart and a happiness for her parents.
Her parents are intelligent, smart. They are an example of love, respect, and a real family for her. Mom is a school principal, a teacher by education. She is sensitive, sweet, kind, and beautiful. She wants to take an example from her. Dad is a builder, he is the best for her. He is a courageous, tall, strong man. He is caring, emotional, loving, with a great sense of humor.
He has an older sister on his mother's side, they are close and friendly, sometimes she is like a second mother, because he spent a lot of time with her as a child.
Donor was a cheerful, obedient, friendly child. She loved spending time with her grandmother. She was accustomed to order. Fair, desperate, friendly. She studied well, the family had a dynasty of teachers, with whom the donor could not relax in her studies. More of a humanitarian, she loved to read, write works. She took an active part in the life of the school - leading at various events, concerts. She showed leadership qualities, was not afraid to take responsibility. She sang, danced, played basketball, attended a sewing club. She was interested in many things, tried herself in everything. Her grandmother taught her to cook, and she still loves to do it. She worked part-time as a confectioner.
After the 11th grade, she entered the university, majoring in Hotel and Restaurant Management. But after the 2nd year she suspended her studies. She went on maternity leave. She plans to resume her studies.
Now she works as a restaurant manager, has made great progress in her career.
She considers it her achievement to have a family, a child, and to be able to combine this with self-development and self-realization in her profession. She was able to become a restaurant manager, it is pleasant to work with her, she is a good leader.
Her special feature is the desire to understand other people, tolerance. Even in difficult situations, she tries to see the positive.
She dreams of traveling with her family, seeing the world. She also dreams of being able to do what she likes, what she is passionate about.
Her family is motivation, love and trust for the donor. She is very grateful to her loved ones for their support, faith in her, for help, without them she would not have coped.
The donor is a reliable, responsible, purposeful and persistent person in her intentions. She is confident in her own abilities, strong-willed, a good leader and organizer. Hardworking, inspired by her own work, persistent. She is an emotional, sensitive person, with a subtle sense of humor, kind, bright, positive, unfailing, always ready to help. In communication, she is open, sincere, sociable, smiling.
