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 a good deed, in which her participation will give another family the opportunity to have children.
The donor, together with her common-law husband, is raising two children - an 8-year-old son and a 6-year-old daughter. Her children are active, energetic, smart and inquisitive. They do karate, learn new things with interest.
They were raised by their mother and their older brother, because their father did not show interest and desire to participate in their upbringing.
For the donor, her mother was always calm, cheerful, sociable, and humorous. Her mother is the kindest, gentlest, loving and closest person for the donor.
The donor recalls that in her childhood she was active, mobile, and positive. She was strong-willed from childhood, able to defend her own point of view. She studied well at school, her favorite subjects were Ukrainian language and literature. She danced and attended creative circles. She was active in school life – she participated in sports competitions, amateur performances, and school olympiads. She also spent her free time actively and in a variety of ways with friends or family – skating, cycling, playing football, etc.
After the 9th grade, she continued her studies at the school. The studies here were more conscious, professionally oriented, and had interesting practical classes. She received a secondary specialized education as a Chef-Confectioner.
After studying, her relationship with her husband developed into a joint family life, and later children were born. Family for the donor is the most important and most valuable thing she has.
Now she works as a sales consultant for household appliances. And she likes to relax actively - sports with her family, walks in nature, cycling, fishing, etc.
Her peculiarity is that she always achieves her goal - she is purposeful and persistent.
Today, she considers her family to be her main achievement, the fact that she is a wife, a good mother to wonderful children.
She dreams of opening her own business - a beauty salon. Because she dreams of changing her field of activity, she would like to become a master of hair extensions, coloring and hair stylist.
She is cheerful, loves interesting communication, sociable. She knows how to listen, understand the interlocutor, empathize.
Friends and relatives say that she is persistent, courageous and kind. She does not tolerate deception, strong-willed. She is straightforward, sincere, open in communication. Kind, smiling, sociable. She says only positive things about those around her. Not conflict-prone, easily finds a common language with different people. Ready to come to the aid of others. Responsible, conscientious, punctual in business.
