Egg donor Questionnaire Декабрь 25, 2021Questionnaires for visitors1 surrogate mother's questionnaireThe questionnaire is not accepted without 3 photos *Name: Middle name: Date of birth: *Nationality: Citizenship: *race EuropoidNegroidMongoloidYour contact phone number (with the city code): *Email Your social media page: Address (place of residence): Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryBody type: *leanmediumfullHeight: *Weight: Blood type: *1234Rh factor: *(+)(-)Do you play sports: YesNootherwhich:Who lives with you: *spousedaughtersonmomotherReceived specialty: Education: HigherNezak.higherSecondary-specialsecondaryotherMarital status: Not marriedMarriedDivorcedThe widowNumber of marriages: Please indicate the birth control devices that you are currently using: condomsOral contraceptivesspiralothercycle regularity: RegularirregularCycle duration 2728293031otherAre you currently lactating? WellnoHave you ever had any experience with surrogacy: YesNoHave you ever had any experience of donation: WellnoHow did you get information about surrogacy?: The InternetAds on the streetFamiliarTheir clinicsFrom the newspaperotherWhy did you decide to participate in the Surrogacy program?: What type of relationship with your family/child do you expect to have after completing the program?: What do you say to the couple who chose you as a surrogate mother to convince them that you will not change your mind after you give birth to their child?: How do you plan to spend the amount of money received for participating in the Surrogacy program?: What would you say if a child born to you in the Surrogacy program wants to meet you?: I have read and accept the rules of the public offer Date Number Own apartment 1-room 2-room 3-room Your private house Hostel We rent a houseSkinny Do you play sports? Living conditions Who lives with you SpouseMotherDaughterSonOtherMarital status Not marriedMarriedDivorcedWidowNumber of marriages 012moreInformation about children Number of children, their age and gender Dates of birth of children Height and weight of children at birth The course of pregnancy How the pregnancy proceeded (the threat of non-gestation, bleeding, increased blood pressure, without features)Due date (in obstetric weeks) Specify the due date of each child Diseases of children after childbirth The way of delivery Information about abortions and miscarriages Abortions, miscarriages, ectopic pregnancy, caesarean section (how many and when) Information about bad habits Smoking Alcohol Drugs Information about bad habits SmokingAlcoholDrugsnoInformation about sexually transmitted diseases What were you sick with and whenDo you have hereditary, chronic diseases Hereditary and chronic diseasesPostponed operations What operations were transferred and whenThe contraceptives you are currently using Start date of the last cycle Date of filling out the questionnaire Textarea Natural hair color BluegrayGreenYellowKaryablackNose shape StraightSkin color BrightBreast size 1Shoe size 35-36Hair color BlondEye color BluegrayGreenYellowKaryablackInformation about hereditary diseases Do you have hereditary and chronic diseases? Have you had an operation Write down what operations you have undergone and when Information about your mother Date of birth Education Type of add-on SkinnySelect Option 1Option 2Option 3how did you get information about egg donation* The InternetEducation HigherCriminal records There areOption 3bad habitsSmokingAlcoholDrugsInformation about hereditary and chronic diseases Type of activity Weight Information about your father Date of birth Height *Weight Type of activity Type of add-on SkinnyEducation HigherCriminal records *There areWithoutbad habitsSmokingAlcoholDrugsConsent to the processing of personal data *By registering (logging in) and/or filling out forms indicating your personal data on the website https://surrogacyfree.com/и on all its subdomains, the user agrees to this Consent to the processing of personal data (hereinafter – Consent), drawn up on the basis of the Personal Data Processing Policy of the international surrogacy agency ISCV "Venus" Acting freely, by his own will and in his own interest, as well as confirming his legal capacity, the User gives his consent, the international surrogacy agency ISCV "Venus" legal address 350901 Kiev, ul. ADDRESS at Addres sin Ukraine . Kiev, PecherskRn., Ul. Mechnikova, 2A Kiev, Ukraine 01001. (hereinafter referred to as the Operator), for the processing of their personal data, including information containing medical secrets, with the following conditions: 1. This Consent is given to the processing of personal data both without the use of automation tools and with their use. 2. Consent is given to the processing of the following personal data: Full name; date of birth; contact phone numbers; email addresses; country of residence, location information; 3. Personal data is not available to subscribers of the resource. 4. Purposes of personal data processing: simplification of the procedure for searching for potential biological parents; online payment, processing incoming requests from individuals and/or legal entities for the purpose of providing advice. 5. The grounds for processing personal data are: Article 11 of the Law of Ukraine "On Personal Data Protection"; 6. During the processing of personal data, the following actions will be performed: collection; recording; systematization; accumulation; storage; clarification (updating, modification); extraction; use; blocking; deletion; destruction. 7. Personal data is processed until the individual withdraws consent to the processing of personal data, which can be sent to the Operator by mail with a notification of reading, or handed over personally to the Operator's representative against receipt. 8. If the subject of personal data or his representative withdraws consent to the processing of personal data, the international agency for maternity care ISCV "Venus" does not provide the User with the opportunity to use the functionality of the site by the User. 9. This consent is valid all the time until the termination of the processing of personal data specified in paragraphs 7 of this ConsentI agree to the processing of personal dataI do not agree to the processing of personal dataFile Upload Date FieldsetInstructions Fill in all the fields. In the Please enter any two digits * field, enter the written digit usually 12 and click Submit. All your questionnaire has been delivered.fee $ VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
Hi there i am kavin, its my first occasion to commenting anywhere, when i read this piece of writing i thought i could also create comment due to this good piece of writing.