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 can have the opportunity to have children, so that another couple can become parents.
The donor has been with her husband for 10 years. He is now a former soldier, two years ago he was discharged from the service due to health reasons. The donor recalls that these were difficult times for their family, their relationship. They had to relearn how to live together in civilian life. They have two children - a 5-year-old son and a 2-year-old daughter. The children show themselves to be sociable, playful, smart and inquisitive. The son is involved in football and dancing. And the younger one tries to repeat everything after her brother. They are healthy, active, mobile children.
The mother died when the donor was 2 years old, unfortunately she does not remember her. At first, she and her father lived with their grandparents, and the donor has warm, cheerful memories of those times. The donor was her grandfather's favorite and tells many funny stories about him. When her father got married and the new family began to live separately, it was difficult for the donor, her relationship with her stepmother was not pleasant. Therefore, as soon as she had the opportunity to choose, she chose to live with her grandmother.
About the donor's father, he says that he is a serious, collected, strict person. He is responsible and conscientious. He has a hobby - making wood products, which he does well.
The donor has been responsible, persistent, precise and neat since childhood. She studied well, her favorite subjects are mathematics and literature. She has logical and mathematical thinking. She also has creative abilities, artistic taste. She draws well, was engaged in modeling. She took an active part in school life, amateur art.
She was a busy child - studying, clubs, helping adults with household chores. She has several close friends with whom she is interested in communicating, spending time during walks.
After the 9th grade, she entered the pedagogical college. During her student years, she was active in organizing various events, performances, competitions. She was also a member of the student council.
She received secondary education and continued her studies in this specialty at the university, received a higher education, a bachelor's degree - a primary school teacher.
She now works as a sales consultant in a specialized store. In recent years, she does not see herself as a school employee, she has become uninteresting, plus there is insufficient financial motivation.
She considers her specialty to be the ability to do something beautiful with her own hands, for example, custom-made cakes, or her own manicure, or "bouquets" of food.
Her main achievement is motherhood, her children, who are the best.
She dreams of a big house with a yard where a big shaggy dog will run around, and a forest can be seen from the window.
She is an independent, responsible, punctual person. It is easier for her to do it herself than to ask others. The donor is not conflict-prone, but when she is sure of her own rightness, she will defend her position. She can be stubborn.
In communication, the donor is pleasant, open, sincere, and friendly. She has a sense of humor, is positive, and optimistic.
