Egg Donor Profile Egg Donor Profile Egg Donor Profile 2026 Step 1 of 5 20% First Name or InitialsEgg Donor-Fresh CyclePictues Here with descriptionMax. file size: 1 GB. Per Cycle Egg Donor CompensationStatusAvailableUnavailableRepeat Donor or SurrogateNoYesHealth Insurance CompanyCity, State, Country City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Are you willing to travel out of state for up to 5 days?YesNoAre you willing to travel out of country for 7-10 days?YesNoOccupationDescription of duties, days and hours worked, hourly rateAre you legally married?YesNoYour Month and Year of Birth MM slash DD slash YYYY Your HeightYour WeightBMIBlood TypeNatural Eye ColorNatural Hair ColorHair TypeBody TypeComplexionEthnicityRace/National OriginChildren Parent's Ancestry: (please be as specific as possible; e.g., French, English)Relations Mother Father Maternal GMA Maternal GFA Paternal GMA Paternal GFA MotherAgeHairEyesHeightWeightHealthOccupationFatherAgeHairEyesHeightWeightHealthOccupationMaternal GMAAgeHairEyesHeightWeightHealthOccupationMaternal GFAAgeHairEyesHeightWeightHealthOccupationPaternal GMAAgeHairEyesHeightWeightHealthOccupationPaternal GFAAgeHairEyesHeightWeightHealthOccupationFamily EthnicityFather’s MotherMother’s MotherFather’s FatherMother’s FatherReligionReligion at BirthPracticing?Have you received any tattoos in the last yearYesNoNumber of tattoos and date of last tattooHave you received any piercings in the last yearYesNoNumber of piercings and date of last piercingOther distinguishing featuresMarital StatusNumber of DivorcesDate(s) of Divorce(s) MM slash DD slash YYYY Have you everFiled for bankruptcy?Been in a psychiatric facility?Been arrested?Been involved in any legal cases, or any that are pending?Been in a substance abuse program?Do you own a car?YesNoDo you drive?YesNoDo you have a valid driver's license?YesNo Medical / Genetic InformationWere you adopted?YesNoDo you have information about your biological parents?YesNoBlood TypeWhat Method?For how long?Number of Miscarriages (please include approx. date, how many weeks gestation, and any known reason)Number of Abortions (please include approx. date, how many weeks gestation, and reason)Date of last OBGYN visit MM slash DD slash YYYY Date of last Pap Smear MM slash DD slash YYYY ResultsPlease note you must have a full OB physical to include pap smear, CBC w/diff, TSH, A1C, and vitamin A/D levels within 12 months of application. Has your weight changed dramatically in the last five years for reasons other than pregnancy?YesNoAre you using birth control?YesNoSexual OrientationNumber of PregnanciesAny complications experienced with this method?Do you smoke or vape?YesNo(Please note that Egg Donors and Surrogates may not have smoked or vaped within 6 months from starting the matching process and must not smoke or vape during the contracted period with us.)Do you drink alcoholic beverages?YesNoHow Often? (per day/week, etc.)Have you ever used illicit drugs?Are you currently using illicit drugs?YesNoAre you currently or in the past 12 months have you used marijuana?YesNoIf so, what dates and how often. What date did you stop.Do you have regular monthly menstrual cycles?YesNoPlease provide detailsHas anyone in your family had difficulty achieving pregnancy?Are there twins or triplets in your family?Have you or any of your partners ever had a blood transfusion?Have you ever had any psychological counseling (including marriage counseling)?Hospitalized for psychiatric illness?Are you currently sexually active with anyone other than your partner listed on this application?Have you ever been physically abusedYesNoHave you ever been sexually abusedYesNoHave you ever had thoughts or attempted suicide?If yes, have you had professional counseling?Do you suffer from Bipolar Disorder?Do you suffer from any Anxiety Issues?Have you ever been sexually assaulted?Have you or your husband or partner or any past sexual partners ever been diagnosed with HIV or AIDS?Please describe any medical problems you may have/hadPlease list any medications and dosage you are currently taking.Please list all other prescription medication (other than birth control), dates taken, reason for prescription, and dosage taken over the last year: I will be completing an egg donor cycle, and this will require medication for follicle stimulation and retrieval.Please list any hospitalizations, surgeries, or plastic surgeries you have had and the dates and reason each event occurredHave you or any past sexual partners ever been diagnosed with the following (please include approx. dates and treatment used)ChlamydiaSyphilisGonorrheaHPVGenital HerpesHepatitis BHepatitis COvarian CystPIDHave you received any vaccines in the last 5 years? If so, please let us know which vaccine and what date.Have you received the COVID Vaccine? If so, which vaccine and shot dates?If any of your biological relatives have suffered from the following, please list their relation to you:Down's syndromeMental retardationSeizure disorder/EpilepsyMuscular DystrophyDeafness or hearing problemsBlindness or Color BlindnessCorrective Lenses/Glasses as a child/teenGlaucomaNearsighted or Farsighted as a child/teenSchizophreniaSuffers from depressionSerious birth defectHeart ProblemsMore than 2 miscarriagesSkin discoloration/spots/rashesCancer - what typeSevere bleeding tendency (hemophilia)StrokeUlcerOvarian cystsUterine FibroidAsthmaHyperactivityAlcoholismDrug AddictionDiabetes prior to age 55 Education / EmploymentPosition Duties TermPositionTermDescriptionPositionTermDescriptionEducationWhat were your best subjects in school?Please indicate which applies to youHigh School GraduateYear of GraduationOverall GPAUniversity/Years Completed/Degree Pursuing/MajorOccupational School/College/University (in order starting with most recent)Associate DegreeBachelor DegreeMaster DegreePhDPsyDSAT ScoreACT ScoreMCATIQ Test and ScoreGPA in CollegeHigh School GPADo you have plans on furthering your education? Please give detailsWhat are your goals in life? Traits / CharacteristicsPlease describe your personality and characterWhat are your hobbies, interests and talents?Do you play a musical instrument?Do you have any particular athletic abilities?What do you like to do in your spare time?What is your philosophy on life?Why do you want to be an Egg Donor?Briefly explain your understanding about how the Egg Donor program works.If you have children, what do you plan to tell your children about you being an Egg Donor or Surrogate?What qualities would you consider most important in choosing a Recipient Couple?What relationship do you want with the Intended Parents during donation, conception, and/or pregnancy?Please indicate who you are NOT willing to work withWill you work with an Intended Parent that has HIV (suppressed)?Will you work with an Intended Parent that is hepB positive?Will you work with single Intended Parent?Will you work with a gay Intended Parent?Have you ever placed a child for adoption?What contact would you like during the process with the Recipient Couple, if any?What kind of relationship do you want to have with your couple after the birth, if any?How would you respond if the child(ren) wanted to see you at some time later in his or her life?What message would you like to pass on to the Recipient Couple? Best of luck!Would you like to meet the Recipient Couple? This can be by zoom, skype, facetime, or in person:I am ok with anonymous or a meeting virtually to begin withPlease explain your answer and type of preferred meetingPlease complete the following sentencesI most valueI am most proud ofI believe thatI dislikeMy immediate goalsMy future plans areMy most memorable childhood experienceMy favoriteFoodColorSeasonHolidaySportBookSongTV ProgramSinger/GroupMovieHobbiesA Letter to Intended Parents
