• desk@ukrainiansurrogates.com
  • +380800301323

Apply online to become an egg donor

Egg donor candidate online application

Submitting an application will not have any legally binding consequences for you.

All information is confidential and may not be transferred to third parties in accordance with the legislation of Ukraine and the European Union on the protection of personal data.

Your information is protected by modern encryption protocols and is not stored online.

Please, answer all questions honestly.

    Submission date:




    Personal data:




    Date of birth:




    Nationality:

    Race:

    Blood type:

    Rhesus factor: Factor RH

    Passport details:

    Home address:

    Contact phone: *



    Your email address / Email: *

    Enter your email address again / Confirm email: *

    Education:

    Profession:

    Occupational hazards:

    What / Occupational hazards details:

    Marital status:

    Presence of children / Children:

    Age of latest baby:

    Have you ever had twins or triplets in your family?

    Experience in surrogacy or donor programs:

    The presence of chronic diseases, what? / Chronic illnesses:

    Harmful habits:

    Smoking:

    Drinking (frequency / absent):

    Use of drugs and psychotropics (never used / with frequency / regularly):

    Syphilis, gonorrhea, hepatitis (had / had not):

    Have you ever had a positive or uncertain response when tested for HIV, hepatitis B or C virus?

    Are / were you registered with sexually transmitted diseases or psychiatric and neurological diseases institutions?

    Do you have a regular menstrual cycle:

    The duration of the menstrual cycle (days):


    Did you have miscarriages or abortions? (term, count, year):

    Past gynecological diseases:

    Height (cm):


    Weight (kg):


    Do you have any experience of participating in an egg donation program (year, name of the clinic)?:

    Hair type:

    Hair color:

    Eyes size:

    Eye cut:

    Eye color:

    Face form:

    Nose size:

    Nose form:

    Forehead:

    Tattoos, scars:

    Body type:

    Clothing size:

    Shoe size:

    Bra size:

    Character traits:

    Flatfoot:

    Cellulite:

    Photo 1:

    Photo 2:

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    For any queries or assistance please call:

    +380800301323