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 like charity and helping people. It's good that someone will have children with her help.
The donor and her common-law husband are raising an 11-year-old daughter. She studies well, has a talent for mathematics, is persistent, purposeful, self-confident. She is sociable, dances, and attends creative circles.
The donor's parents are divorced, but they all maintain friendly relations with each other, as they are sociable, kind, and friendly people. The donor has two younger brothers.
The donor says about her mother that she is hardworking, persistent and diligent in her work. She raised her children this way from childhood, which shaped the donor as a purposeful, serious, and collected person.
The donor's father is a person with a sense of humor, an interesting conversationalist, open and sincere in communication.
Donor was an active, energetic child. Since childhood, she sought to control everything, plan and act according to plan. Responsible, persistent, purposeful. She was engaged in dancing, attended various clubs. She is sociable and talkative. She studied well, rather in the humanities. She played sports. She was restless and energetic, so she was curious about everything but also had a desire to change her interests. She also sought to spend her free time actively in the company of friends.
After 11 grades, she studied at a technical school, where she received a secondary education in the field of Commercial Activities.
After that, she entered university, but with pregnancy she decided to leave her studies for an indefinite period.
Now she works as an operator at a gas station cash register.
Her special feature is kindness and sensitivity, with which she is ready to pity and understand everyone, to come to the aid of people and animals.
She considers her achievements to be that she learned to drive a car, passed her driving test and is actively gaining driving experience.
Her dreams are now more material – she dreams of buying a house for her family, a car and having financial stability.
Friends and relatives say that at first glance she is serious, but then it becomes clear that she is kind, sensitive, caring, and trustworthy.
The donor makes a pleasant impression, she is sociable, talkative, friendly, and open to communication. She is responsible, conscientious, persistent, and purposeful. She has the respect of others, and respects the boundaries and positions of others. She knows how to build a dialogue, establish contact. She has an active life position, leads a sporty and healthy lifestyle. She is energetic, mobile, positive, and optimistic.
