ONLINE APPLICATION FOR EMBRYO
DONATION
EMBRYOS ALIVE
Thank you for choosing Embryos Alive to assist
with your donation.
To assist you in finding the right family for your embies please provide the
following information:
Applicant one (Female)
Please use the information for sperm donor and or egg donor:
Please provide the following contact information
for Applicant 2:
Applicant 2 Male
Please use sperm donor information
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HOW quickly do you want to go in the process? |
As
quickly as possible
Just
getting started
A
year would be great
We
are currently pregnant so after birth (due date)
- Other/Comments:
-
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HOW Did You Hear about e.a.? |
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Understanding of embryo Donation and adoption
briefly explain |
-
Number of Embryos to Donate
Number of Cells
Year they were stored
Quality or grade (if known)
Please request the form from your
clinic so they can send you a copy of your embryology results, blood lab results
(and if you used an egg or sperm donor please request their summary called "letter of
eligibility")
Pictures are always requested! Identifying information will be blacked out.
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Adoption preferences
About the adoptors you would like to choose |
Choose from the following options:
Married
Single
Either Married OR Single
Someone who needs a
surrogate to carry
Comments
Age Preference of Adoptors:
Under 30
30- 40
40 -49 under
60
No Preference
Case By Case
Basis
Number of Children Adoptors Could Have
Note: Some families have step children, his children from another
marriage, her children from another
marriage, older children, and/or
adopted children.
Adoptors religion and level of importance
Comments
Can the adoptors be from a foreign country?
Yes
No
Case By Case Basis
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Level of openness preference with adoptive family of embryos |
Choose from the following options