EPANDED PROFILE : Eve654
SOME INTERESTING FACTS ABOUT: YOUR STAR SIGN: WHAT DO YOU CONSIDER AS YOUR BEST FACIAL FEATURE: WHAT DO YOU CONSIDER TO BE YOUR BEST PHYSICAL FEATURE: HOW WOULD YOU DESCRIBE YOUR SMILE: HOW WOULD YOU DESCRIBE YOUR LAUGH: WHICH ACTRESS OR FAMOUS PERSON YOU THINK YOU RESEMBLE: Eve654 Gemini Eyes Bum Laughable Loud and infectious Keira Knightley FAVOURITES FOOD/S: BOOK/S: MOVIE/S: SONG/S: DO YOU PLAY A MUSICAL INSTRUMENT? FAVOURITE MUSICAL INSTRUMENT: ACTOR/ESS: COLOUR: CAR: FLOWER: GEM STONE: ANIMAL: TIME OF DAY: SEASON: DESTINATION: HISTORICAL FIGURE: PERSON YOU WOULD MOST LIKE TO MEET: WHY? FAVOURITE SUBJECT @ SCHOOL: ANY SPECIAL AWARDS/ACHIEVEMENTS: FAVOURITE QUOTE: Italian, Salads, McDonalds Dis Ek, Anna Comedies Rock and Pop Yes - Piano Piano Charlize Theron Blue Volkswagen Polo Rose Emerald Dogs and horses Night Summer Namibia Jan Van Riebeeck Albert Einstein Because of his beautiful mind Maths, Geography and Languages Medals and a trophy for netball If you can dream it, you can live it. PERSONAL PREFERENCES/ABILITIES ARE YOU SKILLED: HOW WOULD YOU RATE YOUR ABILITY IN MATH: LITERARY SKILLS: SCIENTIFIC/ RESEARCH ABILITIES: ARTICTIC TALENTS: MUSIC SKILLS / ABILITIES: ATHLETIC ABILITIES: HOW MANY LANGUAGES CAN YOU SPEAK? MECHANICALLY / TECHNICALLY 2: English and Afrikaans
SPECIAL SKILLS & PERSONALITY OF FAMILY MEMBERS Music / Artistic / Athletic / Scientific / Math skills / Personality / Employment / Hobbies / Other interesting facts MOTHER: My mother is a teacher at a primary school. She is caring and loving but can be strict when necessary. She is a great cook and loves working in the garden. She plays a little bit of piano and loves walking and going to the gym. FATHER: My father works at a car dealership. He is caring, loving and easy going. He is also a great cook. He loves to braai and enjoys camping. He is fond of playing golf and walking with his dogs. BROTHER: My brother is a hard working agricultural student. He is very committed to what he is doing. He loves sports and enjoys working with large cattle. DONORS HANDWRITING SAMPLE KEIRSEY TEMPERAMENT: GUARDIAN Guardians are the cornerstone of society, for they are the temperament given to serving and preserving our most important social institutions. Guardians have natural talent in managing goods and services--from supervision to maintenance and supply -- and they use all their skills to keep things running smoothly in their families, communities, schools, churches, hospitals, and businesses. All Guardians share the following core characteristics: Guardians pride themselves on being dependable, helpful, and hard-working. Guardians make loyal mates, responsible parents, and stabilizing leaders. Guardians tend to be dutiful, cautious, humble, and focused on credentials and traditions. Guardians are concerned citizens who trust authority, join groups, seek security, prize gratitude, and dream of meting out justice. Guardians can have a lot of fun with their friends, but they are quite serious about their duties and responsibilities. Guardians take pride in being dependable and trustworthy; if there's a job to be done, they can be counted on to put their shoulder to the wheel. Guardians also believe in law and order and sometimes worry that respect for authority even a fundamental sense of right and wrong, is being lost. Perhaps this is why Guardians honour customs and traditions so strongly -- they are familiar patterns that help bring stability to our modern, fast-paced world. Practical and down-to-earth, Guardians believe in following the rules and cooperating with others. They are not very comfortable winging it or blazing new trails; working steadily within the system is the Guardian way, for in the long run loyalty, discipline, and teamwork get the job done right. Guardians are meticulous about schedules and have a sharp eye for proper procedures. They are cautious about change, even though they know that change can be healthy for an institution. Better to go slowly, they say, and look before you leap. Guardians make up as much as 40 to 45 percent of the population, and a good thing, because they usually end up doing all the indispensable but thankless jobs the rest of the population takes for granted. Guardian Portraits: Mother Teresa, William Howard Taft, Harry S. Truman, George Washington
FACIAL CHARACTERISTICS Face Shape: Oval Eye Shape: Hooded / Down Turned / Almond / Round / Protruding Eye Set: Narrow / Close / Average / Deep/ Wide Eye Size: Small / Average / Large Eye colour: Blue Lip Shape: Full / Thin / Flat upper Lip / Perfect / Large top lip / Droopy shape Nose Shapes: Wavy / Snub / Flat / Aquiline / Upturned / Straight Hair Line: Straight / Round / Widow s Peak Hair Texture: Average / Thick / Fine / Coarse / Thin Hair form: Wavy (slight) / Slightly Curly / Straight / Ethnic Hair Colour: Medium Brown Premature Graying: Yes / No, If yes, at what age: N/A Present hair loss: None / Thinning Complexion: Medium Tan Ability: None / Slight / Medium / Easy Cheek Bones: High / Low / Wide / Flat / Pointed Facial Features: Moles / Freckles (few) / Dimples / Beauty Spots / Cleft Chin / Gap tooth /Overbite/ None PHYSICAL CHARACTERISTICS Body Shape: Full hour glass Height: 1,75m Weight: 80.0kg BMI: 26.1 Build: Petite/Small/Medium/Athletic/Large/Stocky Hands: Right-handed/Left-handed/Ambidextrous
MEDICAL PROFILE PERSONAL HEALTH HISTORY Blood Group (ABO): N/A Rhesus: N/A Are you adopted? No Are either of your parents adopted? No Vision (without corrective lenses): Poor / Fair / Good / Excellent Do you wear corrective lenses? No If yes, for what problem(s)? Farsighted / Short-sighted / Other: Explain: N/A Hearing (without corrective aids): Poor / Fair / Good / Excellent Do you wear corrective aids? No If yes, for what problems? N/A Do you smoke cigarettes? No If yes, how many per day? N/A Do you drink alcohol? No If yes, how often? N/A Diet: Vegetarian / Non vegetarian / Other: Allergies: None If yes, are they to: Food(s) / Medication(s) / Cosmetics / Environmental / Animals / Insects For each allergy, describe specific substance and reaction(s) and age first noticed: Substance: N/A Reaction(s): N/A Age: N/A Explain allergies you have outgrown: Allergic to cats when I was younger. Exercise/ Sporting activities: None / Occasional / Regular Type of Exercise: Gym and netball Have you had any surgery (ies)? None If yes please explain: N/A Have you had any hospitalisation(s) not mentioned above? N/A Have you had a blood transfusion? No Are you a blood donor? No Have you ever been excluded from blood donation for reason of infectious disease? No Have you had major radiation or x-ray exposure? No If yes, explain: N/A Have you had any psychological or psychiatric care? No If yes, explain: N/A Are you currently taking any medications, prescribed or over the counter? No If yes, please list: N/A Are you currently using any recreational drugs? No If yes, please list: N/A Do you have any physical deformities for which you have sought surgical corrections? No If so, please explain: N/A
Have you ever been tested as a carrier of? Carrier Non-carrier Unknown Tay-Sach s disease Sickle Cell disease Thalassemia Cystic Fibrosis FERTILITY HISTORY AMH: Not tested, as AFC was found to be suitable by a Fertility Specialist AFC: Measured Have you ever been pregnant? No Do you have any children? N/A If yes, please complete below: Sex: Year of birth: Health Status: Any special comments concerning your children? Are you currently on any form of birth control? Yes Do you have a regular period? Yes Is there any history of fertility problems in your family (difficulty conceiving or miscarriages)? No PSYCHOLOGICAL ASSESSMENT All our donors undergo psychological screening prior to their first donation. This assessment and subsequent assessments are valid for one year. If you would like more information on this donor s assessment; we will put you in touch with the psychologist responsible for the donor s evaluation. The clinic may require you to sign consent before you proceed with the donor.
Eye Colour Hair Colour Complexion Height Weight Build SEUAL HEALTH HISTORY Have you or any of your sexual partner been in contact with anyone or have personally been treated for any of the following: NO TO ALL Self Partner When HIV NSU (non specific urethritis) Syphilis Gonorrhea Chlamydia Venereal Warts Herpes Viral Hepatitis B or C Hemophilia Received human-derived clotting factor concentrates IV (intravenous) drug use Other sexually transmitted diseases Do you practice safe sex at all times? Yes Do you consider your sexual practices risky for HIV infection? No Have you or any of your sexual partners: -engaged in sexual relations with a partner of the same sex during the last 5 years? No -had sex in exchange for money or drugs in the preceding 5 years? No -within the past 12 months undergone tattooing, acupuncture, ear or body piercing? No FAMILY HEALTH HISTORY (Natural eye & hair colour; fair/light/medium/dark complexion; small/medium/large frame/build) Mother Brown Brown - 1.65m 99.0kg Large Father Blue Brown - 1.95m 95.0kg Medium Brother Green Brown - 2.00m 85.0kg Slender Sister - - - - - - Child - - - - - - MGM Blue Brown - 1.50m 50.0kg Small MGF - - - - - - PGM - - - - - - PGF - - - - - - (MGM = Maternal Grandmother, MGF = Maternal Grandfather, PGM = Paternal Grandmother, PGF = Paternal Grandfather, - = Unknown)
How many blood siblings are in your immediate family (including yourself)? 2 Number of Males: 1 Number of Females: 1 How many half siblings are in your immediate family? None If so, from which parent? N/A Number of Males: N/A Number of Females: N/A How many adopted siblings are in your immediate family (including yourself)? None Number of Males: N/A Number of Females: N/A Are there any twins or triplets in your family? No If yes, what relations are they to you? N/A Are there any known genetic diseases or conditions that run in your family? None If yes, please identify: N/A Have you or any family members described above had genetic counseling? No If yes, please describe: N/A Are there any members of your family with a history of learning disabilities? No If yes, please explain: N/A List below the ages of the following biological members of your family; if they are deceased, please list cause of death. Year of Birth Age at time of death Cause of death Mother 1956 - - Father 1951 - - Brother 1994 - - Sister MGM 1931 MGF - 74 Blood clot / Heart attack PGM - Unknown Stroke PGF - Unknown Lung Cancer
Medical problems which are present in biological family members: You Mother Father Sibling MGM MGF PGM PGF HEART Stroke Heart attack Heart disease or defect 1. from birth 2. other Hardening of the arteries High blood pressure Hereditary high cholesterol High cholesterol level BLOOD Anemia Sickle-cell anemia Hemophilia/bleeding disorder HIV / AIDS Leukemia Other blood disorder RESPIRATORY Asthma Lung cancer Emphysema Tuberculosis GASTRO-INTESTINAL Ulcer of stomach/duodenum Hepatitis (all types) Cirrhosis Other liver disease Ulcerative colitis Crohn's disease Pyloric stenosis Multiple Polyposis of colon Rectal disorder METABOLIC/ENDOCRINE Diabetes (age of onset) Thyroid disease Goiter Hyperactivity Phenyl Ketonuria (PKU) Cystic fibrosis Dwarfism Lupus/other auto immune diseases URINARY Kidney disease Other disease/defect of urinary tract No further information
NEUROLOGICAL Migraines Mental retardation Senility before age 50 Multiple Sclerosis Cerebral Palsy Epilepsy/seizure Hydrocephalus Spina bifida neural tube defect Tuberous Sclerosis Parkinsonism Creutzfeldt-Jakob Disease Scoliosis MENTAL HEALTH Depression Schizophrenia Manic depressive/bipolar disorder Alcoholism Drug abuse, misuse or addiction MUSCLE/BONE/JOINTS Muscular dystrophy Loss of muscle coordination Other chronic muscle disease Osteoporosis Marfan Syndrome Arthritis SIGHT/SOUND/SMELL Deafness before age 60 Deformity of the ear Cataracts before age 50 Blindness Colour blindness Severe Myopia Glaucoma Retinoblastoma Retinitis Pigmentosa Other sight/sound/smell disorder SKIN Acne Albinism Eczema Pigmentation disorders Neurofibromatosis Other disorders of the skin CANCER Breast Ovarian Colon Skin Thyroid Cervical Uterine Other Lung GENETIC / CHROMOSOME Down Syndrome Turner Syndrome Fragile Syndrome OTHER PGF was a smoker. You Mother Father Sibling MGM MGF PGM PGF