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:
This is the donor’s first donation program, she saw an ad on a social network, became interested and learned more information on our clinic’s website. She decided to try to become a donor. She got pregnant at 16, and her mother supported her to give birth to a child. Her mother said that she couldn’t get pregnant right away, so she should appreciate the opportunity to become a mother. This is both a continuation of the family, and a new life for the whole society, and the preservation of the gene pool. Therefore, her mother also supports the decision to become a donor, saying that it is a good thing. The donor told her loved ones and family that she would be a donor.
Currently, the donor is a 3rd year college student, studying to be an interior designer.
She is not married, in a civil marriage. When she is studying, she lives with her parents and 1.5-year-old son. She says about her son that he is active, mobile, energetic, quickly developing and learning about the world.
Her parents help the donor a lot, support her so that she can continue her studies and develop. The donor appreciates this very much, wants to live up to their and her own expectations. For her, family is support, reliability, her little cozy world, where she always wants to return.
The donor's mother is a choreography teacher at a school. She is strict, but fair. She will always support, give competent advice, and judge fairly.
Her father works in a bookstore. He is very kind, gentle, open, and emotional, just like her.
The donor was a well-mannered, obedient child. She studied well, was active, and athletic. She did dancing and taekwondo. She studied English with her grandmother. She liked to draw, and later became interested in web design. In her free time, she liked to visit the park, cinema, exhibition, and concert with her friends.
After school, she entered college, where she is currently studying. She manages to study with interest and ease, and has good relationships with teachers and peers. She strives for new knowledge, experience, and development.
The greatest achievement today is the birth of her son, and that she continues to study and develop well in parallel.
She is creative, can draw well, has artistic and aesthetic taste.
She dreams of parachuting, experiencing new emotions, exciting sensations, testing herself for "strength".
Those close to her say that she is sociable, non-conflict, positive and sweet. She is calm, kind, balanced, talented and inquisitive. She is confident in her own abilities, strong-willed, purposeful and persistent. She is also friendly, open, positive.
