Create donor profile

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

Inverted Triangle

Oblong

Oval

Rectangular

Main profile photo

(This is the photo egg donation recipients will view with your summarised profile details; please only use photos of yourself as a child, no adult photos). If you cannot upload the photos, please send directly to baby2mom Egg Donation Agency on babymom.info@gmail.com

File name:

File size:

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.

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? *

How many eggs were produced and do you know the result? *

Were your eggs confirmed good to donate again? *

Any comments around your previous donation if applicable *

Where did you hear about baby2mom *

Which social media platform? *

Do you remember which site? *

Are there any periods when you may not be available? *

Are you pregnant? *

Are you sexually active? *

Details of contraceptives *

Do you have regular monthly menstrual cycles? If not explain *

Please explain why *

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 *

Please list concerns *

In which town/city do you live? *

In which province do you live? *

Nationality *

Where were you born? *

What language(s) do you speak? *

Age *

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 *

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

What is your usual or ideal weight? *

Build *

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 *

Cup size *

Shoe size *

Do you have any facial features like freckles, dimples, etc.? *

Please list these features *

Are you left handed or right handed? *

With celebrity do you most resemble - physically? *

How many siblings do you have? *

Sibling 1 hair colour *

Sibling 2 hair colour *

Sibling 3 hair colour *

Sibling 4 hair colour *

Sibling 5 hair colour *

Sibling 6 hair colour *

Sibling 7 hair colour *

Sibling 8 hair colour *

Sibling 9 hair colour *

Sibling 10 hair colour *

Sibling 1 eye colour *

Sibling 2 eye colour *

Sibling 3 eye colour *

Sibling 4 eye colour *

Sibling 5 eye colour *

Sibling 6 eye colour *

Sibling 7 eye colour *

Sibling 8 eye colour *

Sibling 9 eye colour *

Sibling 10 eye colour *

Sibling 1 build *

Sibling 2 build *

Sibling 3 build *

Sibling 4 build *

Sibling 5 build *

Sibling 6 build *

Sibling 7 build *

Sibling 8 build *

Sibling 9 build *

Sibling 10 build *

Are you a virgin? *

Ever miscarried? *

No. of children *

Child 1 date of birth *

Child 2 date of birth *

Child 3 date of birth *

Child 4 date of birth *

Child 5 date of birth *

Child 6 date of birth *

Child 7 date of birth *

Child 8 date of birth *

Child 9 date of birth *

Child 10 date of birth *

Fertility Issues *

Are you a twin? *

Are you adopted? *

Smoker *

Would you consider your lifestyle *

Any current diseases? *

Please list *

Alcohol consumption per week *

Do you wear glasses? *

How would you rate your sight out of 10? *

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

Please list *

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? *

Please list *

Have you had any cancer *

Please detail type of cancer *

Have you had any heart problems? *

Please list *

Please indicate if you have any allergies *

Please list *

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. *

Please list *

Any physical handicaps or deformaties? If yes, please state *

Please list *

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? *

Please list *

History of Asthma *

Indicate any medication you are taking and reason for it *

Have you ever been addicted to any substances? *

Please explain *

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

Please list *

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 *

Please list *

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

Please list *

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? *

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 *

Display format: e.g. English 67%, Maths 80% etc.

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? *

What was the score? *

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 *

Display format: Strengths - cooking and public speaking; etc.

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? *

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 *

Details of twins *

Any family members who have had cancer including aunts or uncles? *

Please provide details about cancer in your family *

Any fertility problems in your family *

Please provide details about 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? *

Please provide details of health concerns in your family *

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? *

Please provide details of genetic diseases in your family *

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 *

Please provide details of mental diseases in your family *

Any physical deformaties or handicaps? If yes, please state *

Please provide details of physical deformities or handicaps in your family *

History of Asthma *

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

Please provide details of skin disorders in your family *

Any other comments regaring any health aspects in your family *

Alcoholism / Substance Abuse *

Grandmothers still alive? *

Current age or age of death *

Grandfathers still alive? *

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 *

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: *

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

Please advise any specific donation criteria other than those mentioned *

Criteria details *

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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