Egg Donation

Are you a U.S. Citizen?*

As a donor, you must agree to maintain a permanent residence in your current state until after the Egg Retrieval. Do you acknowledge and accept this requirement?*

Have you ever given birth before?

Have you previously been a donor?

Have you traveled outside of the United States in the last 6 months? *

Is there any family medical history such as diabetes, cancer, heart disease, etc?

Are you and your spouse/partner willing to undergo a criminal background check?

Have you ever been convicted of a felony?

Are you willing to undergo a psychological screening and evaluation test ? *

Have you ever received treatment for depression?*

Have you ever been diagnosed with any type of mental illness?*

Do you currently smoke tobacco?*

Do you currently use recreational drugs such as marijuana or cocaine etc.?*

Have you ever received treatment for drug or alcohol abuse?

Have you ever had an eating disorder?

Are you comfortable giving yourself injections if trained by a healthcare professional?

You will be required to take daily medications and/or injections for up to 4 months. Do you acknowledge and accept this requirement?

You will be required to complete all required testing including psychological screening, sexually transmitted disease and drug testing. Do you acknowledge and accept this requirement?

Have you or your spouse/partner ever had a sexually transmitted disease ?

Do you have both Ovaries?*

Do you have regular periods?

Are you currently on any form of birth control?

Do you currently have an IUD? Ex: Depo provera or implant *

As a donor, you and your partner must abstain from sexual intercourse during the Egg Donor process (approximately 2-4 weeks). Do you acknowledge and accept this requirement?

Are you willing to travel outside of US (All expenses paid)?

Have you been positive for Covid 19?

By my signature below, I certify that the above information is complete and correct. I have not omitted any information that would make the above information inaccurate or misleading. I certify that the above information I have provided is true and correct*