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 sees the donation programs as a charitable cause that she has the opportunity to join. She is happy to help other couples become parents.
The donor is divorced, has three children. The eldest daughter, 11 years old, is a beautiful, intelligent, talented and creative girl. The middle son is 5 years old, he is a kind, gentle boy who is interested in technology, how everything works, and is fond of mathematical thinking tasks. The youngest daughter, who is now 3 years old, loves to draw, create something beautiful with her own hands. She is emotional, cheerful, energetic.
The donor talks about her father with admiration and respect. He was a strong personality, a “man of his word”, brave, caring. He was a leader and a born entrepreneur. He passed away 9 years ago, he was 20 years older than his mother.
The donor’s mother is an emotional, friendly, active, cheerful person. She loves her garden, where she grows flowers, especially roses. She is a creative person, has good taste, and a talent for drawing. For the donor, she is close, loving, gentle, and kind, always supportive in various life circumstances, loves her grandchildren and helps take care of them.
The donor has a brother who is 10 years older than her and already has his own family and two children. Their family is large, noisy, cheerful, they are friendly, close and supportive of each other.
The donor had a capricious character in childhood, she sought to receive as much attention as possible. She likes everything to be the way she wants. Sociable, persistent, with clearly manifested leadership qualities. She studied well, she had a greater inclination towards the humanities. She was fond of literature, adored drawing, embroidery, needlework. Everything she took up - she did well.
After the 9th grade, she finished the 10th and 11th grades in one year as an intern, and worked in parallel. She wanted to earn money on her own as soon as possible, to buy what she wanted.
She graduated from a vocational school, where she received a secondary specialized education as a Cook.
She is currently in the process of organizing her own business, wants to open a cleaning company and realize her dreams, develop and grow financially.
The donor's special feature is her creative talent - she knows how to make beautiful things with her own hands and sell them. She sewed underwear, made soap, etc.
Her main achievement is the ability to provide herself and her family with everything they need - 3 children.
She dreams of her own car, which she wants to learn to drive. And also to raise children and give them a good education.
The donor is an ambitious, purposeful, stubborn and strong-willed person. If she has a goal, she will be able to overcome any obstacles on the way. She believes in herself, is self-confident, strong in spirit. The donor is emotional, original, sociable. She has demonstrated organizational and leadership qualities, knows how to negotiate with other people, defend her position.
