Become an Egg Donor at Blue Sky Fertility

Questionnaire

Blue Sky Fertility
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Become an Egg Donor with Blue Sky Fertility

Estimated completion time:
3-5 minutes

Thank you for your interest in becoming an egg donor! The application process consists of two phases:

1) The Prescreen Questionnaire (complete below): This is a short questionnaire that screens you on basic egg donor qualifications. Once you pass this stage of the application process, you will be prompted to complete the full questionnaire.

2) Full Questionnaire: Once you submit this short prescreen questionnaire and it is accepted, you will be prompted to complete the full-length questionnaire. The full questionnaire is a slightly more involved survey that dives into more detail on everyone's favorite topic - YOU! So to get started, sit back, relax and complete the pre-screener questionnaire below:

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1) First Name *

2) Last Name *

3) Date of Birth *

4) Address *

	.
Street
City
State
Zip

5) Primary Phone Number *

6) Do you agree to receiving text messages and phone calls? *

7) Are you a US Citizen or do you have a work visa? *

8) What is your height? *

9) What is your current weight (in lbs.)? Your weight will be confirmed at our office. *

10) What is your natural hair color? *

11) What is your natural eye color? *

12) What is the highest level of education you have completed? *

13) What race and/or ethnicity best represents you? *


	Caucasian
	East Indian
	Black/African American
	Middle Eastern/Arabic
	Hispanic/Latino
	Native Hawaiian/Pacific Islander
	Asian
	American Indian/Alaska Native
	Mixed/Multi-Racial

14) Do you use nicotine products (i.e. cigarettes, e-cigarettes, nicotine gum, etc.)? *

15) Do you smoke marijuana or use marijuana products? *

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