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Profile Details
Member Type
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Couple / Individual
Egg Donor
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First Name
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Last Name
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Phone Number
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Phone Type
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Cell Phone
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Preferred method of contact
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E-Mail
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Address
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City
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State
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Zip Code
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Can you commit to the donation process for at least 5 months?
Required
Yes
No
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Date of birth
Required
Day
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
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January
February
March
April
May
June
July
August
September
October
November
December
Year
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2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
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1963
1962
1961
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1959
1958
1957
1956
1955
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1953
1952
1951
1950
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Height
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Less than 5 foot
5 ft.
5 ft. 1 in.
5 ft. 2 in.
5 ft. 3 in.
5 ft. 4 in.
5 ft. 5 in.
5 ft. 6 in.
5 ft. 7 in.
5 ft. 8 in.
5 ft. 9 in.
5 ft. 10 in.
5 ft. 11 in.
6 ft.
6 ft. 1 in.
6 ft. 2 in.
6 ft. 3 in.
6 ft. 4 in.
6 ft. 5 in.
6 ft. 6 in.
6 ft. 7 in.
6 ft. 8 in.
6 ft. 9 in.
6 ft. 10 in.
6 ft. 11 in.
7 ft.
More than 7 ft.
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Weight (pounds)
Required
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Your Parentage
Required
Natural Child of Parents
Adopted
Donor Conceived
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What is your highest level of education?
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Did not finish high school
High school diploma or equivalent
Some vocational/Trade school completed
Vocational/Trade school in progress
Vocational/Trade school completed
Some associate degree completed
Associate degree in progress
Associate degree completed
Some Bachelor degree completed
Bachelor degree in progress
Bachelor degree completed
Some Graduate degree completed
Graduate degree in progress
Graduate degree completed
Some Medical degree completed
Medical degree in progress
Medical degree completed
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Racial Background
Required
Black
Asian
Caucasian
Hispanic
African
Middle Eastern
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Are you a US citizen?
Required
Yes
No
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Do you have both ovaries?
Required
Yes
No
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When was the last time you smoked/vaped/chewed tobacco or ingested nicotine? Honesty is critical: we will verify answers through a urine/blood test.
Required
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Within last two weeks
Within two to four weeks
Within one to three months
Within three to six months
More than six months
Never
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Have you ever been convicted of a felony?
Required
Yes
No
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Have you or any of your family members been diagnosed with alcoholism or drug addiction?
Required
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No
Yes - Father
Yes - Mother
Yes - Sibling
Yes - Self
Yes - More than one family member listed above
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Are you currently taking medications for or have you ever been diagnosed with Bipolar Disorder?
Required
Yes
No
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Are you currently pregnant?
Required
Yes
No
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Are you currently breastfeeding?
Required
Yes
No
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When was the last time you smoked Marijuana?
Required
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Within past three months
Within the past year
Within the past two years
More than five years ago
Never
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Have you, in the past two years, used any of the following: Heroin, Cocaine, Barbiturates, or Amphetamines?
Required
Yes
No
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Are you a registered member of a Federally-recognized Native American/Canadian Indian tribe or eligible to register as part of a Federally-recognized
Required
Yes
No
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Hair Color
Required
Black
Auburn
Brown
Blonde
Red
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Eye Color
Required
Brown
Amber
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Blue
Hazel
Gray
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Skin Tone
Required
Light
Medium
Medium-Light
Medium-Dark
Dark
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Blood Type
Required
A-
A+
B-
B+
AB-
AB+
O-
O+
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Religion
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Christian
Judaism
Islam
Buddhism
Hinduism
Catholicism
Other
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Employment Status
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Employed (Full-Time)
Employed (Part-Time)
Student
Unemployed
Self Employed
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Are you currently a father of your own biological children?
Required
Yes
No
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In the last 12 months have you been diagnosed or treated for any infectious disease?
Required
Yes
No
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How many births have you had? (Please record twins, triplets, etc. as 1 birth)
Required
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0
1
2
3
4
5
6
7
8
9
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Have you been on any anti-depressant/anxiety medications in the last 12 months?
Required
Yes
No
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Are you receiving any government assistance?
Required
Yes
No
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