Grace Donors - Members

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Dear Potential Grace Donor

We would like you to consider the following before proceeding with the Grace application form:

1. A Grace Donor, if/when chosen to donate will be required to attend 7 clinic appointments, will you be able to commit to the time as they happen during working hours – not after hours or on weekends.
2. Do you have the full support of your family? Husband, Boyfriend, Partner, Parents, etc?
3. Have you read the Grace Donor FAQ's? If not, please visit this link as they are extremely helpful
https://gracedonors.co.uk/egg-donation/egg-donor-faq/

In which City do you currently live

First Name

Last Name

Birth Date

-- Only ages between 18 and 35 permitted

Are you HIV Positive?

Have you or any of your immediate family been formally diagnosed by a medical professional as suffering from any of these serious mental disorders: bipolar / schizophrenia / other serious mental disorders ?

Are you a virgin?

Please note that BMI (body mass index) has a serious effect on fertility. Your BMI must be within the required range of 18 to 28. If / When you are chosen, both your height and weight will be checked by the nurse at the clinic when you attend your first appointment. Donors whose BMI is under or above the required range will not be eligible to donate

Height in Meters/Feet

Weight in Kilograms/Pounds

Is your period regular?

Donation Location

Do you live / work more than 100kms from London?

What method of birth control are you using?

Why would you like to become a donor?

Have you been a donor before?

Do you smoke?

Are you currently on any medications, herbs or supplements?

Are there any known genetic diseases or conditions that run in your family? Please give their details below

Conditions	Family Member with Condition (Incl Grandparents)	Medication Prescribed	Age of Onset

Your Email Address

Would you like a second email address to be copied in on all correspondence?

Home Phone

Work Phone

Mobile Phone

Choose a Registration Password (longer than 4 characters in length)

Confirm your chosen Password

How did you hear about Grace Donors?

Extra details on how you heard about Grace Donors:

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