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DFS509

DFS509

 

  • Ethnicity

    1/2 Asian, 1/2 Caucasian

  • Height

    5'9" (Feet/Inches)

  • Weight

    135 LBS 

  • Eye Color

    Brown

  • Hair Color

    Brown

  • Blood Type

    O

  • Distinguishing Features

    • High Cheekbones
    • Long legs
    • Small waste
    • Large eyes
    • Great smile

  • Age

    29

  • Availability

    Currently Available

  • Education

    2 years of colege then hired on as a Manager for a Fashion Company.

  • Ivy League or Top 20 College

    NA

  • Achievements

     

  • Artistic Talents

     

  • Athletic Achievements

     

  • Donation Preference

  • Reason for Donating

     

  • Donation History

      Date Clinic Agency Compensation No. of Eggs/Embryos Pregnancy
    1st Donation New Donor          
    2nd Donation            
    3rd Donation            
    4th Donation            
    5th Donation            

  • Compensation

     

  • No. of Relatives

    Number of Relatives

      Brothers Sisters Maternal Aunts Maternal Uncles Paternal Aunts Paternal Uncles
    Number of Relatives            

  • Family Demographics

     

  • Family Education

  • Family Personalities & Traits

  • What famous person or public figure would you play

  • Daily Activities

     

  • Personality & Disposition

     

  • Passion & Hobbies

     

  • Childhood & Adolescent Personality

     

  • Growing Up

     

  • Admire Most

     

  • Famous Person Donor would Play in a Movie

     

  • Travel Wishes

     

  • Favorite Things


     

  • Neurological History

    Medical Condition

    Family      Member    

    		 Age        

    Current

    Condition                     

    		 Age of Death
    ADD or ADHD NA      
    Autism / Asperger's NA      
    Learning Disability                                 NA      
    Mental Retardation NA      
    Paralysis  NA      
    Dementia NA      
    Epilepsy NA      
    Alzheimer's NA      
    Multiple sclerosis NA      
    Parkinson's                      NA      
    Migraines NA      
    Age-related issues                                       NA      

  • Gynecological History

    Medical Condition Yes    No   
    Infertility NA  
    Prior Cervical Surgery (LEEP, Cone Biopsy) NA  
    History of DES exposure NA  
    History of abnormal PAP smear NA  
    Prior uterine surgery NA  
    History of uterine malformation NA  
    History of uterus opening up too early NA  
    History of uterine, ovarian or breast cancer NA  
    Fibroids, PCOS or Endometriosis NA  
    Hysterectomy NA  
    Multiple or Late Trimester Miscarriages NA  
    Miscarriages, still births, or neonatal deaths NA  

  • Medical Treatments

      Condition            Diagnosis          Treatment       Result           
    1. NA      
    2.        
    3.        
    4.        
    5.        
    6.        

  • Surgeries

      Surgery          Reason     Completed Outcome 
    1. NA      
    2.        
    3.        
    4.        
    5.        

  • Psychological

    Condition

    Family

    Member                   

    		 Age         

    Current

    Condition                       

    		 Age of Death 
    Alcohol or Drug Addiction NA      
    Depression NA      
    Panic Attacks NA      
    Schizophrenia         NA      
    Bipolar Disorder                                    NA      
    Age-related NA      

  • Mental Health

      If Yes, please explain No
    Have you ever been hospitalized for mental illness?   ✔️
    Have you ever considered committing suicide?   ✔️
    Have you ever tried to intentionally hurt yourself?   ✔️
    Have you ever tried to hurt a child or baby?   ✔️
    Are you currently in counseling?   ✔️
    Have you ever had an eating disorder?   ✔️

  • Family Health History


     

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