Get Ucsf Medical Center Egg Donor Program Interest Form: Initial Questionnaire

Filling out the UCSF Medical Center Egg Donor Program Interest Form: Initial Questionnaire is a crucial step for individuals interested in becoming egg donors. This guide provides a structured approach to completing the form with clarity and ease.

Follow the steps to successfully complete your questionnaire.

1. Press the ‘Get Form’ button to access the form and open it in your designated editing tool.
2. Begin by entering your name and date of birth in the appropriate fields.
3. Fill out the contact information section, including your street address, city, home phone, cell phone, email, and state. Ensure you include your zip code.
4. Next, provide your personal information, including your race/ethnicity, education level, field of study, university/college attended, current employment status, and relationship status.
5. Enter your height and weight in their respective fields.
6. In the pregnancy history section, detail the number of pregnancies, specifying dates and outcomes for births, miscarriages, terminations, and ectopic pregnancies.
7. Document your menstrual history by providing the date of your most recent menstrual period, average cycle length, and any menstrual problems or pain experienced.
8. Describe your current health status, including any medications you are taking, existing illnesses, and any genetic or mental health conditions.
9. List your personal medical history, detailing any surgeries, past medications, and diagnoses of conditions.
10. Provide your birth control history, including types used, duration, and start/end dates.
11. Outline your family medical history, specifying conditions such as diabetes, cancer, or heart disease within immediate and extended family.
12. Explain your motivation for wanting to become an egg donor.
13. Share your thoughts on the compensation offered for egg donation, currently set at $10,500.
14. Detail your current time commitments and availability, ensuring to mention any work, school, or volunteer activities, and specify if weekday appointments are manageable.
15. If applicable, indicate prior egg donations, mentioning the location, outcomes, and any comments.
16. State if you have ever been treated for a sexually transmitted infection, including the type and dates.
17. List any travel outside of the United States, specifying destinations and dates.
18. Indicate if you have received any tattoos or new piercings in the last 12 months, confirming whether they were done under sterile practices.
19. In fewer than 500 characters, summarize who you are as a person, considering how you would present yourself to a recipient.
20. Indicate how you heard about the UCSF Egg Donor Program and provide details if responding to an advertisement.
21. Once all fields are completed, save the form on your computer. Email a copy to the Egg Donor Program at crhdonorcoordinators@ucsf.edu, including 'Initial Questionnaire' in the subject line.
22. You can expect to be contacted within two weeks regarding the next steps, if applicable.

Complete the form online today to take your first step toward becoming an egg donor.