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DONOR 1
Fullname
Amna Jamal
Country
Canada
Address
----------------
Eye Color
Green
Hair Color
Red/Auburn
Height
5.4
Ethnicity
Other
Sample
Education
Associates degree
Hobbies
Listening to music, Motocross, Hiking, Photography, Sewing/knitting, Using a computer, Playing video games, Playing sports, Playing an instrument, Gardening, Collecting things
Anything else would you like to mention about your family medical history to the
Adoptive parent
Nothing
Anything else would you like to mention about your talents,skills,interests
Dancing
DONOR 2
Fullname
Micheal Harris
Country
Canada
Address
---------------
Eye Color
Blue
Hair Color
Blond
Height
4.7
Ethnicity
Latino/Hispanic
Education
High school
Hobbies
Keeping pets, Being a leader of a group, Going to church/temple
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
N/A
BASIC INORMATION
Full name
Amna Jamal
Micheal Harris
Country
Canada
Canada
Address
----------------
---------------
Eye color
Green
Blue
Hair color
Red/Auburn
Blond
Height
5.4
4.7
Ethnicity
Other
Sample
Latino/Hispanic
Education
Associates degree
High school
Hobbies
Listening to music, Motocross, Hiking, Photography, Sewing/knitting, Using a computer, Playing video games, Playing sports, Playing an instrument, Gardening, Collecting things
Keeping pets, Being a leader of a group, Going to church/temple
Anything else would you like to mention about your family medical history to the
adoptive parent
Nothing
N/A
Anything else would you like to mention about your talents, skills, interests
Dancing
Photos
PHOTOS
EMBRYO
How many embryos do you wish to donate
What are the grades of the embryos?
2
----
Have the embryos been genetically tested
Yes
Do you know the gender of the embryos
Yes
Have the embryos from this batch resulted in a life birth
Age of embryos when they were frozen
5-7 days
How long ago the embryos were created
Genetic mother’s age at the egg retrieval
Less than 5 years ago
Less than 25 years old
Have the embryos from this batch been already donated to another adoptive parent
Yes
Embryo
MEDICAL HISTORY
DONOR 1
DONOR 2
Allergy
Donor
Donor child
Alzheimer
your parent, your grandparent
Anxiety
your parent
Asthma
your parent
You
Autism
your child
Bipolar disorder
your grandparent
Cancer
Celiac disease
Cystic fibrosis
Depression
your parent
Diabetes
Donor child
your grandparent
Epilepsy
Donor
Fibromyalgia
Donor
Fragile X syndrome
Donor child
Heart conditions
Donor's grandparent
Hemochromatosis
Donor child, Donor's parent
High blood pressure
Huntington’s disease
Donor's grandparent
Lupus
Donor child
Marfan syndrome
Donor
Multiple sclerosis
Obesity
Phenylketonuria
Polycystic kidney disease
Rheumatoid arthritis
Schizophrenia
Stroke
Substance abuse
Tay-Sachs disease
Donor child, Donor's parent, Donor's grandparent
Medical Histroy
DONOR 1
Allergy
Donor
Alzheimer
your parent, your grandparent
Anxiety
your parent
Asthma
your parent
Autism
your child
Bipolar disorder
your grandparent
Cancer
Celiac disease
Cystic fibrosis
Depression
your parent
Diabetes
Donor child
Epilepsy
Donor
Fibromyalgia
Donor
Fragile X syndrome
Donor child
Heart conditions
Donor's grandparent
Hemochromatosis
Donor child, Donor's parent
High blood pressure
Huntington’s disease
Donor's grandparent
Lupus
Donor child
Marfan syndrome
Donor
Multiple sclerosis
Obesity
Phenylketonuria
Polycystic kidney disease
Rheumatoid arthritis
Schizophrenia
Stroke
Substance abuse
DONOR 2
allergy
Donor child
alzheimer
anxiety
asthma
You
autism
bipolar disoder
cancer
celiac disease
cystic fibrosis
depression
diabetes
your grandparent
epilepsy
fibromyalgia
fragile x syndrome
heart conditions
hemochromatosis
high blood pressure
huntington's disease
your grandparent
lupus
Donor's parent
marfan syndrome
multiple sclerosis
obesity
phenylketonuria
polycystic kidney disease
your grandparent
rheumatoid arthritis
your grandparent
schizophrenia
stroke
substance abuse
Information on egg/sperm donor
Letter
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