Height, cm: 164 Weight, kg: 71 Blood type and Rh factor: A (II) Rh+ Ethinicity: caucasian Religion: christianity Character traits: I am a kind and fun person
Eye color: blue Eye shape: european Nose: straight Forehead: normal (straight) Face: oval Freckles/moles: yes
Hair type: straight Hair color: chestnut-haired Grey hair: no Constitution: mesomorphic (normal constitution) Right-handed or left-handed: right-handed
LIFE STYLE
Marital status: married Career field: sales Education: secondary vocational Languages: russian
Favorite sport: ice skating Play musical instruments: no Hobbies, interests: I love animals
Why did I become a donor?
By becoming a donor I understand that I am helping a family to have a child
Preferences
Favorite food: potatoes in any shape and form Favorite color: blue Favorite season: spring, summer Favorite holiday: 12 June – St.Petersburg day
Favorite book: Fairy Tales Favorite music genre: any kind of music Favorite film: “Who if not Us” Pets: a cat, a dog, 2 spiders
Information about children
Children: 2 Sex: girls 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; 3 of 5
Have you ever worn braces?; No
Do you smoke?; No
Do you drink alcohol? How often?; Rarely
Do you have allergies? If you do, please, specify; Yes, to protein
Do you take prohibited substances?; No
Have you ever had blood transfusion?; No
Have you ever been hospitalized?; No
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; Chronic ear infection
Do you take any medications? If you do, please, specify; No
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