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 she is doing a good deed, helping people become parents. It is nice to know that she can be involved in the birth of a new life.
The donor has been married for over 13 years, has two sons – 7 and 12 years old. She always dreamed of being a mother, so she became a young mother. Her children are kind, obedient, beautiful. The eldest son is more flexible, gentle, you can negotiate with him. The younger one is more strong-willed, characteristic. They study well, do better in mathematics. They are interested in fishing, mopeds and cars.
Her family is her life, it is the most valuable thing of all. For her, it is strong love, valuable trust, sincere relationships and reliable support.
The donor's parents divorced, and when the donor was 15 years old, her mother went to live in another place and did not maintain communication. She was raised by her father and grandmother. Her grandmother is the closest person to her. Her grandmother is like a mother to her. She is sensitive, kind, loving, she is ready to give her all for her and her children.
The donor's father is kind, caring, will always help, support. She can trust, lean on him.
The donor herself was a stubborn child, if she had a goal, she achieved it. She felt from childhood that she had no one to rely on, so she matured early, understood that she had to study, develop, grow. She studied well, humanitarian subjects were easier for her. She was engaged in ballroom dancing, drawing. She participated in various performances, competitions, etc. She is a creative person, inquisitive, easily learns everything new. She is sociable, always surrounded by friends, interesting companies.
After the 9th grade, she entered a technical school, received a secondary education as a computer operator. She got married and gave birth to her first son. And then she decided to look for herself in a creative profession, so she went to study again and received the profession of a hairdresser. What she does to this day - she works as a hairdresser in her small town. This work is a joy and pleasure for her, she plans to continue improving her skills and gaining experience.
Her achievements are that she is a good specialist, self-realized, has a wonderful family, a good mother.
Her special feature is self-confidence and her own abilities.
Her hobby is driving, because it brings her pleasure and she is passionate about it.
She dreams of having her own mini-salon.
Her loved ones consider her stubborn, because she always does what she thinks is right. Her relatives listen to her more, they take her opinion into account.
She is purposeful, will go to the goal in any case, in her work she brings things to the end. She is honest, decent, a person of her word. She is punctual, accurate in business, order and comfort are important to her. She is collected, serious, businesslike and strong-willed.
