Qualification Questions

Congratulations! You’ve taken the first step toward giving an incredible gift.

The questions below will help determine if you meet our minimum qualifications to become an egg donor.

Name*

First Last

What City & State do you reside?*

City State

Email*

Enter Email Confirm Email

Are you between the ages of 20 – 28?*

Yes
No

Is your BMI below 30?*

You can use this BMI calculator

Yes
No

Do you smoke or use tobacco in any form?*

Yes
No

Are you currently taking any anti-depressants or anxiety medications?*

Yes
No

Can you obtain accurate, up-to-date health information on your biological parents, grandparents and siblings?*

Yes
No

Have you ever been diagnosed with ADD/ADHD or any other type of learning disability?*

Yes
No

Have you ever tested positive for the HIV virus, HTLV infection, Hepatitis B virus or Hepatitis C virus?*

Yes
No

In the past 12 months have you undergone tattooing, ear piercing or body piercing?*

Yes
No

In the past 12 months have you been treated for or had Syphilis, Chlamydia, or Gonorrhea?*

Yes
No

Have you traveled outside of the US in the past 12 months?*

Yes
No

Have you ever been or applied to be an egg donor before?

Yes, I've applied, was accepted and donated before
Yes, I've applied, was accepted but never donated
Yes, I've applied but was denied
No, I've never applied before

How many times have you donated before?

Have you applied or been screened to be an egg donor with other agencies?

Yes
No

Which clinic(s) and location(s)?*

How did you hear about us?*

Who did you get referred by?*

What magazine?*

Egg Donor Application

Qualification Questions