Donor Application Form

Height :

Weight :

Hair Color :

Hair Type :StraightWavyCurly

Eye Type :Almond-shapedBigSmall

Eye Color :

Skin Color :

Body Structure :AthleticSlimPlump

Face Shape :OvalRoundSlimLongAngular

Nose Shape :SmallWideBonyBig

Forehead Shape :WideNarrowNormal

Ear Shape :SmallBigDroopy

Hand & Foot Structure :LongSlimThickShortGraceful

Shoe Size :

Clothing Size :

Inherited Conditions in the Family :

Do you have any Skin Conditions? :

Marital Status :MarriedSingleDivorced

Do you have children? :YesNo

If yes, their Ages and Genders :

Surgeries and Dates :

Psychological Disorders :

Accidents and Dates :

Past Illnesses :

If Others, please specify :

Ethnicity of Parents :TatarKazakhMongolian

Other Ethnic Origins :

Family Diseases :DiabetesHypertensionRheumatismCancer

Other Diseases :

Psychological Problems :

High School Department :

University Department :

College and Master's Degree :

Foreign Languages :

Smoking :YesNoQuit

Number of Cigarettes per Day :

Age of Starting and Quitting Smoking :

Alcohol: How Much Do You Consume per Week? :

Substance Abuse :

Allergies :

Specify :

Do You Have Allergies That Were Observed at an Early Age but Do Not Show Symptoms Now? :

Character Traits :

Diet Preferences :

Favorite Foods :

Foods You Don't Like :

Phobias :

Hobbies :

Tattoos or Piercings :

How Would You Describe Your Character? :

What Makes You Special? :

What Do You Love Most About Yourself? :

Your Interests, Skills, and Talents :

Your Future Goals :

Your Favorite Childhood Memory :

Why Do You Want to Become a Donor? :

Menstruation Cycle :

How Often Do You Exercise? :

Which Types of Exercises Do You Enjoy? :

Have You Had Any Sexually Transmitted Infections? :

Fetal Anomaly :

Tests Performed :

Description :

Routine Tests :

Message to Families (Optional) :

Submit