top of page

11012024_2

&

11012024_1

DONOR 1

Fullname

11012024_2

Country

United States

Address

Eye Color

Brown

Hair Color

Dark Brown

Height

6'3"

Ethnicity

White/Caucasian

Education

Bachelor’s degree

Hobbies

Camping, Collecting things, Fishing, Hiking, Keeping pets, Playing sports, 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

11012024_1

Country

United States

Address

Eye Color

Brown

Hair Color

Black

Height

5'3"

Ethnicity

Other

Filipino

Education

Bachelor’s degree

Hobbies

Visiting with friends, Working out/exercising, Photography, Playing sports, Bicycling

Anything else would you like to mention about your family medical history to the
Adoptive parent

Ethnicity: Filipino

Anything else would you like to mention about your talents,skills,interests 

BASIC INORMATION

Full name

11012024_2

11012024_1

Country

United States

United States

Address

Eye color

Brown

Brown

Hair color

Dark Brown

Black

Height

6'3"

5'3"

Ethnicity

White/Caucasian

Other

Filipino

Education

Bachelor’s degree

Bachelor’s degree

Hobbies

Camping, Collecting things, Fishing, Hiking, Keeping pets, Playing sports, Visiting with friends, Watching TV or movies

Visiting with friends, Working out/exercising, Photography, Playing sports, Bicycling

Anything else would you like to mention about your talents, skills, interests

Ethnicity: Filipino

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

One Day 5 Hatching Blastocyst AB

Have the embryos been genetically tested

No

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 15 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 child

Donor

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

Huntington’s disease

Lupus

Marfan syndrome

Multiple sclerosis

Obesity

Phenylketonuria

Polycystic kidney disease

Rheumatoid arthritis

Schizophrenia

Stroke

Substance abuse

Tay-Sachs disease

Medical Histroy

DONOR 1

Allergy

Donor child

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

Huntington’s disease

Lupus

Marfan syndrome

Multiple sclerosis

Obesity

Phenylketonuria

Polycystic kidney disease

Rheumatoid arthritis

Schizophrenia

Stroke

Substance abuse

DONOR 2

allergy

Donor

alzheimer

anxiety

asthma 

autism

bipolar disoder

cancer

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
bottom of page