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1.

By selecting "Agree", you are stating that you understand you are applying to be an Egg Donor through Forward Fertility, LLC. You can complete a separate application to be a gestational surrogate at www.forwardfertility.com. *

2.

By selecting "Agree", you are stating that you have answered all questions to the best of your ability, without purposeful omission or deception. You understand that egg donation is considered "tissue donation" according to the FDA. This is a process that requires maturity, as it is a serious issue related to all parties involved. *

3.

Are you a US citizen or permanent resident? *

4.

Are you eligible to work in the United States? *

5.

What is your FIRST name? *

6.

City *

7.

State *

8.

Have you applied, been screened to be an egg donor, or donated your eggs before? *

9.

How many times have you donated your eggs? *

10.

Is your work schedule flexible? *

11.

If a background check were run on you, would it show any problems with the law (i.e. DUI, custody issues, lawsuits)? *

12.

Have you ever had any arrests, convictions, sentences, etc.? *

13.

What is the most number of consecutive days that you have been incarcerated? *

14.

Are you adopted? *

15.

Date of Birth (only your calculated age is shared with Recipients) *

16.

How would you describe your background? (Please select all that apply to you.) *

17.

What is your height? *

18.

What is your weight? *

19.

What is your eye color? *

20.

What is your natural hair color? *

21.

What is your natural skin complexion? *

22.

What is your highest level of completed education? *

23.

Are you currently under a physicians care for any reason? *

24.

Do you have both ovaries? *

25.

What kind of contraception do you use? *

26.

What was your age at the onset of menses? *

27.

Have you ever lost your period due to exercise or weight loss? *

28.

How many pregnancies have you had? *

29.

How many children have you given birth to? *

30.

Have you ever been treated or diagnosed with endometriosis? *

31.

Gestational Carriers are women who are NOT genetically related to the baby they carry for a family. Their compensation starts at approximately $30,000. You must have had at least one full term uncomplicated pregnancy and delivery to qualify. The demand for ideal candidates is high. Would you consider being a gestational carrier? *

32.

Have you ever been seen by psychiatrist, psychologist, social worker, counselor, or any other mental health professional for any reason? *

33.

Have you ever used medications such as antianxiety or antidepressants to treat an emotional or psychological problem? *

34.

How many cigarettes do you smoke per day? *

35.

How many drinks do you usually consume in a week? *

36.

When is the last time you had marijuana? *

37.

When is the last time you have used recreational or illicit drugs (cocaine, LSD, heroin, barbiturates, narcotics, opiates, amphetamines, hallucinogens, tranquilizers, PCP, steroids for non-medical reasons, or etc.)? *

38.

Have you had acupuncture, ear and/or body piercings or tattooing on your body? *

39.

When was the last time you have had a tattoo or body piercing? *

40.

How many sexual partners have you been with during the past 6 months? *

41.

Egg Banking is a process by which mature eggs are removed from a woman's ovary. They can be frozen, unfertilized by any sperm, and thawed at a later date for that woman to become pregnant. Forward Fertility, LLC offers the option for egg donors to bank their own eggs for future use as part of the egg donation cycle (the donor getting some eggs and the recipients getting some eggs) in exchange for a smaller financial compensation. Would you be interested in this option, if you became a donor? *

42.

Where did you hear about Forward Fertility? *

43.

How long have you been considering egg donation? *


What is your email address for communication with you regarding your pre-screen application?
(6-20 characters with 4 or more letters and 1 or more numbers)
(Must match)