AOK Embryo Donation Database Access

Questionnaire

AOK Embryo Donation
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Register for access as an Intended Parent in our embryo donor database.

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First Name *

Last Name *

Street *

City *

State *

Zip *

Your Date of Birth *

Cell Phone Number *

What is your assigned sex? *

When we add new donor to our platform, how often would you like to receive an email? *

Do you have a partner? *

Yes No

Partner's First Name *

Partner's Last Name *

Partner's Email Address *

Partner's Date of Birth *

What is your partner's assigned sex? *

Partner's Cell Phone Number *

What race(s) best describe you and your partner (if you have a partner)? *

Are you single, legally married or partnered? *

Are you working with a clinic? * Yes No

What clinic are you working with?

Do you currently have children? We ask this because our goal is to prioritize assisting individuals and families facing significant fertility challenges. * Yes No

Are you registered with Livestrong and/or are you a cancer survivor? * Yes No

Are you planning to work with a Gestational Surrogate? *

Is there anything you would like us to know about you or your partner's gender identity?

Please share your story about why you are looking for embryo(s) *

Are there any specific traits that you are looking for in an embryo donor (e.g. hair color, eye color, level of education, ethnicity, etc)?

How did you hear about us? *

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Email Address *

Password *

8 characters minimum

One special character (e.g. * or !)