Exclusive Donor Initial Registration Form

First Name

Last Name

Phone

Country

Street Address

City

Date of Birth

Sun Mon Tue Wed Thu Fri Sat

Measurement System

Imperial System

Metric System

Height

Weight

lbs

Marital Status

Residence status in Ukraine

Do you live in the Ukraine?

In which country were you born?

Were you adopted?

Do you currently use prescription medication or drugs, such as marijuana, for non-medical purposes?

Do you smoke cigarettes or use nicotine in the form of a vape?

I have delivered one or more healthy children.

Do you have any genetic disorders?

Have you ever applied for or been selected for egg donation?

How did you hear about us?

Please upload one or two high-quality photos of yourself.

Photo 1
Required

Photo 2