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DONOR 1
Fullname
09102023_1
Country
USA
Address
Eye Color
Black
Hair Color
Black
Height
5'2
Ethnicity
Asian
Education
High School
Hobbies
Collecting things, Farming, Gardening, Hiking, Horseback riding, Keeping pets, Listening to music, Motocross, Sewing/knitting, Taking care of animals, Taking care of people, Visiting with friends, Watching TV or movies
Anything else would you like to mention about your family medical history to the
Adoptive parent
Anything else would you like to mention about your talents,skills,interests
DONOR 2
Fullname
09102023_2
Country
USA
Address
Eye Color
Black
Hair Color
Black
Height
5'08
Ethnicity
Asian
Education
High School
Hobbies
Camping, Cooking, Eating, Fishing, Going to church/temple, Hiking, Listening to music, Photography, Playing video games, Taking care of people, Using a computer, Visiting with friends, Watching TV or movies, Woodworking, Working out/exercising
Anything else would you like to mention about your family medical history to the
Adoptive parent
Anything else would you like to mention about your talents,skills,interests
BASIC INORMATION
Full name
09102023_1
09102023_2
Country
USA
USA
Address
Eye color
Black
Black
Hair color
Black
Black
Height
5'2
5'08
Ethnicity
Asian
Asian
Education
High School
High School
Hobbies
Collecting things, Farming, Gardening, Hiking, Horseback riding, Keeping pets, Listening to music, Motocross, Sewing/knitting, Taking care of animals, Taking care of people, Visiting with friends, Watching TV or movies
Camping, Cooking, Eating, Fishing, Going to church/temple, Hiking, Listening to music, Photography, Playing video games, Taking care of people, Using a computer, Visiting with friends, Watching TV or movies, Woodworking, Working out/exercising
Anything else would you like to mention about your talents, skills, interests
Anything else would you like to mention about your family medical history to the
adoptive parent
Photos
PHOTOS
EMBRYO
How many embryos do you wish to donate
What are the grades of the embryos?
1
6AB
Have the embryos been genetically tested
Yes
Do you know the gender of the embryos
No
Have the embryos from this batch resulted in a life birth
Age of embryos when they were frozen
Yes
not sure
How long ago the embryos were created
Genetic mother’s age at the egg retrieval
less than 5 years ago
less than 35 years old
Have the embryos from this batch been already donated to another adoptive parent
No
Embryo
MEDICAL HISTORY
DONOR 1
DONOR 2
Allergy
Donor's parent
Alzheimer
Anxiety
Asthma
Autism
Bipolar disorder
Cancer
Donor's parent
Celiac disease
Cystic fibrosis
Depression
Diabetes
Epilepsy
Fibromyalgia
Fragile X syndrome
Heart conditions
Hemochromatosis
High blood pressure
Donor's parent
Huntington’s disease
Lupus
Marfan syndrome
Multiple sclerosis
Obesity
Phenylketonuria
Polycystic kidney disease
Rheumatoid arthritis
Donor's parent
Schizophrenia
Stroke
Substance abuse
Tay-Sachs disease
Medical Histroy
DONOR 1
Allergy
Donor's parent
Alzheimer
Anxiety
Asthma
Autism
Bipolar disorder
Cancer
Celiac disease
Cystic fibrosis
Depression
Diabetes
Epilepsy
Fibromyalgia
Fragile X syndrome
Heart conditions
Hemochromatosis
High blood pressure
Donor's parent
Huntington’s disease
Lupus
Marfan syndrome
Multiple sclerosis
Obesity
Phenylketonuria
Polycystic kidney disease
Rheumatoid arthritis
Donor's parent
Schizophrenia
Stroke
Substance abuse
DONOR 2
allergy
alzheimer
anxiety
asthma
autism
bipolar disoder
cancer
Donor's parent
celiac disease
cystic fibrosis
depression
diabetes
epilepsy
fibromyalgia
fragile x syndrome
heart conditions
hemochromatosis
high blood pressure
huntington's disease
lupus
marfan syndrome
multiple sclerosis
obesity
phenylketonuria
polycystic kidney disease
rheumatoid arthritis
schizophrenia
stroke
substance abuse
Information on egg/sperm donor
Letter
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