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 would like to help families who want to have children, but for some reason cannot. She is sorry that someone feels unhappy because of this.
The donor's family today is her and her daughter. Her child is 5 years old, she is an emotional, energetic, capricious girl. She also persistently achieves what she wants, talkative, cheerful.
The donor's parents divorced when she was little, her mother had marriages after that, so the donor has two younger brothers and a little sister.
The donor has no communication or relationship with her father, he did not show interest in her, so she does not seek this anymore.
She has a close relationship with her mother, now they are like friends with her. The donor's mother is distinguished by seriousness, property, perseverance. She is a strong woman who raised 4 children, actively worked so that her family had everything they needed. She is like the "commander in chief" in everything - in finances, in work, in the family.
Donor is the oldest child in the family, so she was an example for the younger ones - responsible, collected, balanced. Since childhood, she was more reserved and silent, but as she grew older, leadership and organizational skills began to appear in her. She became more sociable, open, emotional.
She studied well, was fond of history, literature, and learning languages. She was an active, lively, inquisitive child. She danced, played volleyball, and drew well. She tried herself in all local clubs.
After the 9th grade, studying at the school, an exciting student life began - a new company of friends, interesting studies, gaining practical work skills, and her first earnings.
Donor has a secondary specialized education as a cook-waiter. Now she works as a confectioner - she prepares cakes to order. This is both a hobby, a favorite thing, and a job for her. She makes her sweets from the heart, wanting her clients to receive joy and taste pleasure.
She considers the purchase of her own car to be her achievement. Also, the development of her business - confectionery, in which she realizes herself, improves and is successful.
Her specialty is the ability to adequately perceive life, herself. She is demanding and strict towards herself, works on her shortcomings. Sincere, honest, decent.
She dreams of financial prosperity, a good job, her own housing, the opportunity to travel the world, and give her child all the best.
Donor is a friendly, emotional, responsive person. Pleasant, open, direct in communication. She is also balanced, responsible, punctual and purposeful.
