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 knows that there are couples who cannot have children naturally. She was interested in this problem, what these people are going through, how they strive for it. Therefore, she decided to help with what she can - to share what she has. She believes that donation is a good thing.
The donor is married, her husband is a paramedic in an ambulance. She has two sons - 4 and 5 years old. They are active, inquisitive, restless. Sociable, kind, open to communication. They are interested in cars and various equipment.
The donor's mother works in a hospital. She is kind, calm, does not know how to refuse, is always ready to come to the rescue.
The father is an agrarian, a combine harvester. He is generous, kind, and persistent. At the same time, strict, but fair. Courageous, strong, reliable.
She has a sister with whom she also has warm, close and friendly relations. Donor is grateful to her parents for raising her and her sister the best they had. Her family are her close friends.
Donor was a cheerful, bright, active child. She loved adventures, active games, and communication with friends. At the same time, she was obedient, well-mannered, and polite. She studied well, with interest. She liked biology, anatomy, and chemistry. She easily memorized new material, she didn’t have to memorize it for a long time, and she could sometimes afford to be lazy. She danced, drew well, and loved to relax with friends or family.
After school, she entered medical school because she had been interested in medicine and everything related to it since childhood. She received a secondary medical education as a nurse.
She currently works in a medical rehabilitation center.
Her specialty is her desire to help everyone if asked. It is important for her to understand that her loved ones need her and that she can be useful to society.
An achievement for her is that she has two young children, but at the same time develops in her professional field and studies, moving forward despite the difficulties.
She dreams of entering university and getting a higher education and of financial stability and well-being. She also dreams of giving her children a better future, ensuring a happy childhood.
Donor is kind, gentle, usually goes to meet the interlocutor. She does not know how to refuse, sympathizes with others, wants to be useful, help. She is balanced, sociable, has many friends, and this is comfortable for her. She likes to be surrounded by people, communicate, be noticed. She happily organizes meetings, invites guests. She cannot sit in one place for a long time, she needs movement, novelty - activity, travel, meetings.
Donor is sweet, friendly, tactful and sincere in communication. Polite, intelligent. Responsible and punctual, conscientious and hardworking.
