Egg Donor Application

Being a donor is a big responsibility. It requires going to several doctor's appointments, taking injections and hav-ing minor out-patient surgery. Do you feel prepared to commit to this process?

Yes

No

Are you open to being matched with all types of families regardless of sexual preference, marital status, ethnicity or sex of the egg recipient?

Yes

No

If they request it, are you willing to meet your intended parents?

Yes

No

Are you open to meeting the child in the future if that is requested?

Yes

No

Are you open to exchanging future contact information with your intended Parents(s)?

Yes

No

Do you have any siblings? If so, tell us about each of them:

Yes

No

Do you have any children? If so, tell us about each of them:

Yes

No

Any past or current medical problems (including surgeries, accidents, birth defects, depression, etc.)? If yes, please list:

Yes

No

Do you have any known genetic disorders? If yes, please list:

Yes

No

Do you drink alcohol? If yes, how many drinks per week?

Yes

No

Do you smoke?

Yes

No

Have you ever been pregnant? If yes, how many times and what was the outcome?

Yes

No

Have you ever been a donor before? If yes, did a pregnancy occur?

Yes

No

Are you currently taking any medication (for physical or mental health)? If yes, what medications are you on and why?

Yes

No

Are you taking any recreational drugs? If yes, what are you taking?

Yes

No