Fill out the health questionnaire Thank you for wanting to become a donor! Please fill out the health questionnaire, we will contact you soon! First and last name Email Phone number Place of residence (city) Age Nationality Height (cm) Body weight (kg) Hair color Eye color I would like to donateEgg cellsSperm cells Education levelBasic educationVocational educationHigh schoolBachelor’s degreeMaster’s degreeDoctorateOther Do you smoke (if yes, how much per day/week)? Do you consume alcohol (if yes, how much per week/month)? Do you use drugs (if so, how much per week/month)? Have you already had sexual intercourse? Describe your health condition as accurately as possible Describe the health condition of your close relatives. Are there any hereditary diseases or serious health problems? What medications have you taken during the last 12 months? I have read the privacy policy and agree to it. I confirm that the information above is correct I agree that the clinic’s medical staff may access my digital health records
