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 brought curiosity to the donation program first of all - she wanted to find out from her own experience how the program works, whether she is suitable for donation, whether she is physically and genetically healthy. She is also pleased to think that thanks to her participation in the program, someone will become a parent.
Currently, the donor is not working, she is trying to understand what and how she wants to realize herself professionally. She became interested in acting and became passionate about it. She is currently attending training, master classes, and is developing in this direction - acting, choreography, vocals.
The main support for her is her parents. She is the only child in the family, so all the attention and love goes to her.
The donor's mother inspires her respect and admiration for how she managed to overcome various difficulties in life and not lose her kindness, balance, sincerity, openness to the world. The mother strives for self-development, moves forward. She and her mother have a warm, friendly and close relationship, support each other and understand each other perfectly.
The donor's father is emotional, sociable, cheerful with a sense of humor. He is a support and reliability for his family, he treats his mother and the donor with trepidation, he is able to solve all problems, make strong-willed decisions and bear responsibility for them.
The donor has been emotional, active, energetic, sociable since childhood. She is a creative person, she strives to be in the spotlight, surrounded by people, communicate, have friends. Since childhood, she has been engaged in vocals, dancing. Inquisitive and interested in learning, new experiences, knowledge. She studied well at school. She liked such subjects as literature, art, was fond of history and physics. The donor has been interested in psychology since her youth - relationships with herself and others. She attended creative circles. In her free time, she traveled around the country with friends.
She considers sensuality and intuition to be her special feature. She feels people, understands their feelings, has developed empathy. Feels insincerity and deception.
Her main achievement today is that despite the stressful situations in her life, she does not lose faith in a promising future, has goals and moves forward to their realization.
She dreams of happiness. For her, this means realizing herself in all areas of life - having a good job, finding a circle of her interests, having mental harmony and balance.
Donor is talkative, active, energetic, sociable, with a sense of humor. She takes on any business without fear. She is not afraid of change. Emotional, sensual, strong-willed and self-confident. She strives for self-realization and development. She is positive and optimistic. She exhibits such qualities as responsibility and punctuality. Purposeful and ambitious.
