Create donor profile

PLEASE NOTE

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General

Please complete the General questions in order for your application to be considered.

You don’t need to complete the entire form at once. You are able to save a draft of your form scrolling to the bottom and clicking 'Save Draft'

There are 10 steps in this form. Once you have completed a section, click 'NEXT' to proceed to the next step.

If you don't click the SUBMIT or Save Draft link, the information you've completed will not be stored.

Post Title

Race Group *

Age *

Hair Colour *

Hair colour and texture (hair colour as a child)

Eye Colour *

Reproduction History *

Has Children *

Proven Donor *

(Have you donated before with confirmed good egg quality, need not have resulted in a pregnancy, yes or no?):

Post Matric qualifications *

Face Shape *

Round

Square

Triangular

Diamond

Heart

Inv. Triangle

Oblong

Oval

Rectangular

Main profile photo

Select Image

(this is the photo egg donation recipients will view with your summarised profile details). If you cannot upload the photos, please send directly to baby2mom Egg Donation Agency on babymom.info@gmail.com

Date of Birth *

Use the calendar to select your date of birth

Other Physical Information *

(Height, weight, build, other physical traits)

Other Personal Information *

Nationality, Blood group, summary about egg donor (profession, interests, type of person). Message to egg donation recipient.

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Confidential Information

Have you donated eggs before? *

If yes, please advise whether you donated through an egg donor agency?

If yes, with which clinic did you donate?

Where did you hear about baby2mom

If Online – do you remember which site?

Are there any periods when you may not be available?

Are you pregnant?

Are you pregnant? *

Are you sexually active? *

Details of contraceptives *

Do you have regular monthly menstrual cycles? If not explain

No. of times you have been pregnant

Have you ever aborted a pregnancy

Are you breastfeeding? *

Do you have both ovaries? *

Are you at risk of any sexually transmitted diseases

Are there any medical or psychological concern areas that may prevent you from participating as an egg donor

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Initial Information

In which town and province do you live?

Nationality

Where were you born?

What language(s) do you speak?

Age

Year of birth

Star sign

Blood Group (if known) *

Why do you want to be an egg donor and if you had a message for your recipient what would it be?

How do you best describe yourself?

Relationship Status

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Physical Profile

Race *

Skin Complexion *

Face Shape *

Nose Shape defined by Wikipedia *

Eye Shape *

Height in meters *

e.g. 1.68

Weight in kilograms *

e.g. 60

BMI:

What is your usual or ideal weight?

Build and body shape

Which body part is most sensitive to weight gain or loss?

Eye Colour *

Natural Hair Colour *

Hair colour as a child

Hair type *

Hair texture *

Description of hands and fingers

Any other defining traits such as breast cup, size shoe size, freckles, dimples, etc

Are you left handed or right handed? *

With celebrity do you most resemble - physically?

Siblings physical traits - hair and eye colour, height, weight and build

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Reproductive Information

Are you a virgin? *

Ever miscarried? *

No. and ages of children (if applicable)

Fertility Issues

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Health of Egg Donor

Are you a twin? *

Are you adopted? *

Current health status lifestyle and/ or current diseases

Smoker *

Alcohol consumption per week.

Do you wear glasses? *

How would you rate your sight?

Any skin disorders, albinism, ectodermal dysplasia, eczema, acne, etc

Have you suffered from/ currently have any health concerns/ diseases including but not limited to diabetes, cholesterol, blood pressure, thyroid, haemophilia, blood clotting, paralysis, porphyria?

Have you had any cancer *

Have you had any heart problems?

Please indicate if you have any allergies

Any mental or psychological diseases/ learning disorders including but not limited to genetic depression, bi polar, psychiatric illness etc. Please elaborate and indicate if genetic.

Any physical handicaps or deformaties? If yes, please state

Do you have any genetic diseases or are a carrier of any genetic concerns including but not limited to thalassemia, cystic fibrosis and sickle cell?

History of Asthma *

Indicate any medication you are taking and reason for it

Have you ever been addicted to any substances? *

Have you partaken in any recreational drugs had tattoos or piercings in the last six months? Please explain

Details of any operations?

Are there any health issues of which you are aware that may be of concern for you to become an egg donor? If yes, please state

Any specific diet such as vegan, vegetarian, health conscious, low fat, etc.

How often do you excercise? *

In which exercises or sports do you partake now?

Have you excelled in any sports?

What sports did you play at school?

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Professional and Academic Information

Occupation

What is your ideal career/ occupation?

What are you doing to get to your desired profession in life?

Do you have a matric and university exemption *

Subjects and grades or marks at school

What is the name of any course / degree completed?

Planned Studies

In what aspects do you have a keen interest?

What type of books do you like to read?

Would you prefer to read the book or watch the movie?

Do you know if your IQ was ever tested and the score please?

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Behavioural Traits

What is most important in life to you?

If you had unlimited resources and could save one thing on earth what would it be?

What are your views on religion and spirituality, and practiced religion?

Childhood religion?

Any specific achievements or aspects of recognition in your family

Interests and hobbies

What is your preferred holiday?

If you were offered an all-inclusive holiday, what would it be?

Which interesting places have you visited?

What are your feelings on animal welfare?

Strength and Weaknesses

What do others generally think of you?

Favourite flower

What is your favourite meal?

What is your favourite Movie?

What is your favourite Book?

What is your favourite Actor?

What is your favourite Actress?

What is your favourite Colour?

What is your favourite colour lipstick?

What is your favourite perfume?

Who is your favourite person?

Are you more introverted or extroverted?

Would you prefer to go out with friends or stay in with a loved one or book?

Are you musical or played any musical instruments?

Are you more cultural or more adventurous?

Do you prefer indoors or outdoors?

Which weather do you prefer?

Are you more creative or analytical?

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Family Information of Genetic Parents - Please answer each question for your Mother and Father, e.g. Mom – South African, Dad – British.

Nationality for Mother and Father

Country of Origin and Ancestry for Mother and Father

Language spoken for Mother and Father

Professions for Mother and Father

Achievements on an academic level for Mother and Father

Race for Mother and Father

Natural Hair colour for Mother and Father

Eye colour for Mother and Father

Height for Mother and Father

Mother and Father Build

Any specific defining traits for both parents

Are your parents still alive? *

If deceased, cause of death

Age (if living, or age deceased)

Health status

Please indicate if any twins in your family and the relationship to you

Please list any family members who have had cancer including aunts or uncles and on which family side

Any fertility problems in your family

In your family, has anyone suffered from/ currently have any health concerns/ diseases including but not limited to diabetes, cholesterol, blood pressure, thyroid, haemophilia, blood clotting, paralysis, porphyria, heart problems?

In your family, does anyone have any genetic diseases or are a carrier of any genetic concerns including but not limited to thalassemia, cystic fibrosis, sickle cell, tay sachs?

Any Mental or Psychological Disease or learning disability or learning disorders including genetic depression, bi polar, psychiatric illness in siblings or family? If yes, please stateAny physical deformaties or handicaps? If yes, please state

Any physical deformaties or handicaps? If yes, please state

History of Asthma

Any skin disorders, albinism, ectodermal dyslasia or other in your family – please explain

Any other comments regaring any health aspects in your family

Alcoholism / Substance Abuse

Grandmothers still alive?

If deceased, state cause of death

Current age or age of death

Grandfathers still alive?

Deceased? state cause of death

Current age or age at time of death

Grandfathers' eye colour (maternal and paternal)

Grandmothers' eye colour (maternal and paternal)

Grandfathers' hair colour (maternal and paternal)

Grandmothers' hair colour (maternal and paternal)

Health of grandmothers (maternal and paternal)

Health of grandfathers (maternal and paternal)

Please specify if the race of your grandparents is different to yours. If mixed race, please specify race for maternal and patermal grandparents

Any genetic health or psychological concerns worth noting regarding your grandparents

Any notes/ comments re family of family health aspects - genetic ito psychological, physical, deformaties, diseases, concerns

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Egg Donation Stipulations

Please indicate if you have any donation conditions or criteria such as persons to whom you prefer not to donate

Preferred town to donate *

Towns available in which to donate - travel costs will be covered: *

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Confirmation

I have only made myself available as an egg donor with baby2mom. *

Please advise any specific donation criteria other than those mentioned

All information provided is correct and pictures are all of me. I agree to keep baby2mom updated with the donor programe (screening, blood tests, scans, egg retrieval. I will keep baby2mom updated wrt my availability and wrt egg donation pregnancies achieved. I consent to participate in the baby2mom egg donor program and participate as required and understand the concept of anonymous egg donation and claim no further rights over any child(ren) conceived of egg donation. I agree that I will be prescribed medication to potentially synchronise my menstrual cycle with that of the recipients and will be given hormones in a controlled environment by professional fertility specialists to stimulate donor egg developement. I agree to find more information pertaining to egg donation on the baby2mom egg donor site or ask if I have any further questions about being an egg donor. I agree to participate as required as people often travel from international destinations to participate in a South African egg donation program and have incurred considerable financial and emotional costs *

I consider my form complete:

Yes

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