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Egg donor's ID number:
Why did you decide to become an egg donor?
Describe a typical day in your life
Do you have any job or occupation? NoYes
What is your current job or occupation?
What are your professional aspirations?
Do you have any special skills or hobbies?
Which country of the world would you like to visit and why?
What is your favorite place?
What would you consider your strongest and weakest points?
Describe your favorite memory
What are your food preferences?
What is your favorite color?
What have been your greatest achievements?
What goals have you set for the future?
What steps have you taken towards achieving your goal?
What do you like to do in your free time?
What are your biggest needs in life?
What were your favorite subjects in school?
What were your least favorite subjects in school?
Father's nationality
Mother's nationality
Paternal grandfather's nationality
Paternal grandmother's nationality
Maternal grandfather's nationality
Maternal grandmother's nationality
Do you have or have you had any health problems in the past? NoYes
What health problems do you have?
Have you had any sexually transmitted or other diseases? NoYes
What sexually transmitted or other similar diseases have you had?
Have you had any surgeries? NoYes
How many surgeries have you had in your lifetime?
What kind of surgeries do you have?
Do you have any allergies to medications? NoYes
What medications are you allergic to?
Do you have excess body or facial hair? NoYes
In which area do you have excess hair?
Do you have or have you ever had acne, moles, or other marks on your body? NoYes
Where are your acne, moles, or other body marks located?
Have you ever worn corrective lenses? NoYes
Have you ever worn braces? NoYes
Have you ever had problems with your neck or back? NoYes
Have you ever been diagnosed with or suffered from asthma? NoYes
Have you ever suffered from a migraine headache? NoYes
Have you taken vomiting medication or laxatives? NoYes
How did you take laxatives or vomiting medications?
Have you been registered at a psychiatric hospital? NoYes
Have you been registered at a narcological dispensary? NoYes
Have you ever suffered from mental illness? NoYes
Have you ever taken psychotropic medications? NoYes
What psychotropic medications are you taking?
Have you been an egg donor before? NoYes
How many times have you been an egg donor?
Have you previously undergone a full egg donor screening? NoYes
Have you given birth before? NoYes
How many children have you given birth to?
Are you currently breastfeeding? NoYes
How long have you been breastfeeding your baby?
Are there two ovaries? NoYes
Do you use contraceptives? NoYes
What kind of contraceptives do you use?
Do you have a menstrual cycle every month? NoYes
Have you ever had a pap smear? NoYes
Have you had a child who died? NoYes
How many children died?
Have you ever had an abortion due to abnormal fetal development? NoYes
How many abortions have you had?
Education SecondarySecondary professionalHigher
Your qualification
Name of educational institution
Do you have academic degree? NoYes
Which academic degree do you have? BachelorMaster degreeCandidate of SciencesDoctor of Science
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