Height, cm: 170 Weight, kg: 63 Blood type and Rh factor: A (II) Rh + Ethinicity: russian Religion: christianity Character traits: I am a great person, wonderful!
Eye color: Brown Eye shape: european Nose: Medium Forehead: Medium Face: Oval Freckles/moles: None
Hair type: Straight Hair color: Chestnut Grey hair: no Constitution: mesomorphic (normal constitution) Right-handed or left-handed: right-handed
LIFE STYLE
Marital status: Divorced Career field: Medical supplies manufacturing Education: Secondary Vocational Languages: Russian, beginners English
Favorite sport: no Play musical instruments: The piano Hobbies, interests: Music, books, travel
Why did I become a donor?
I wish you good health and happiness!
Preferences
Favorite food: Potatoes, tomatoes Favorite color: Green, orange, blue, white Favorite season: summer Favorite holiday: New Year’s Eve
Favorite book: “Jane Eyre” by Charlotte Bronte Favorite music genre: No Favorite film: “Home alone” Pets: 2 dogs
Information about children
Children: 2 Sex: boy and girl 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?; No
Do you smoke?; No
Do you drink alcohol? How often?; No
Do you have allergies? If you do, please, specify; No
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; No
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