Height, cm: 182 Weight, kg: 78 Blood type and Rh factor: A (II) Rh+ Ethinicity: russian Religion: atheist Character traits: emotional, warm, kind
Eye color: green Eye shape: european Nose: long Forehead: normal (straight) Face: rectangular Freckles/moles: yes
Hair type: straight Hair color: dirty-blonde Grey hair: from the age of 25 Constitution: mesomorphic (normal constitution) Right-handed or left-handed: right-handed
LIFE STYLE
Marital status: single Career field: supplies manager Education: higher Languages: russian
Favorite sport: basketball Play musical instruments: no Hobbies, interests: fitness, drawing, crochet, cooking
Why did I become a donor?
After I have had my own child I spend a lot of time at the playground. That’s where I’ve heard stories of couples that can’t conceive. Then, by chance, I saw an ad in the paper, and decided to try. I am happy if I helped some family to have a child they wanted!
Preferences
Favorite food: caesar salad, pasta with cheese, cakes Favorite color: green Favorite season: autumn Favorite holiday: New Year’s Eve
Favorite book: “Lord of the Rings” by J.R.R.Tolkien Favorite music genre: pop music Favorite film: “Back to the Future” Pets: no
Information about children
Children: 1 Sex: boy Hearing/vision problems: no Mental health problems/autism: no ADHD/hyperactivity: no
Medical and genetic information
Please assess your dental health by 5-grade scale; 4 of 5
Have you ever worn braces?; Yes
Do you smoke?; No
Do you drink alcohol? How often?; Rarely
Do you have allergies? If you do, please, specify; For aspirin
Do you take prohibited substances?; No
Have you ever had blood transfusion?; No
Have you ever been hospitalized?; Yes
Does your family history have twins or triplets?; No
Do you have Ashkenazi Jews as your ancestors?; No
Do you have chronic diseases? If you do, please, specify; Had a gallbladder removed
Do you take any medications? If you do, please, specify; Contraceptive
Have you or your blood relatives ever been diagnosed with any of the following diseases?
Diseases;Donor;Father;Mother;Brothers;Sisters;Grandfather / On father's side;Grandfather / On mother's side;Grandmother / On father's side;Grandmother / On mother's side
Migraine;
Mental disorders;
Epilepsy;
Muscular dystrophy;
Hearing problems/deafness;
Daltonism/blindness;
Hyperopia/myopia; ; +; +; ; +
Glaucoma;
Mental disorders;
Frequent depression;
Congenital disorders;
Clubfoot;
Dwarfism;
Cardiovascular disease;
More than two miscarriages;
Skin pigmentation disorders - vitiligo;
Psoriasis, neurodermatitis, skin hyperpigmentation;
Hair loss (age); ;+; ; ; ; ; +
Oncological diseases (specify type);
Hemophilia;
Heart attacks; ; +
Ulcer;
Ovarian cyst;
Ovarian tumors;
Fibroma of the uterus;
Uterine fibroids;
Alcoholism;
Drug addiction;
Diabetes up to 55 years;
Autism;
Other; ; stroke