• desk@ukrainiansurrogates.com
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Egg Donor Candidate Application

    Submission date:

    Personal data:

    Date of birth:



    Blood type:

    Rhesus factor: Factor RH

    Passport details:

    Home address:

    Contact phone: *

    Your email address / Email: *

    Enter your email address again / Confirm email: *



    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:


    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:


    Tattoos, scars:

    Body type:

    Clothing size:

    Shoe size:

    Bra size:

    Character traits:



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    For any queries or assistance please call: