Become An Egg Donor - Seek Submit Surrogacy | Get Pre Qualified For Egg Donation

Have you ever been diagnosed with bi-polar, schizophrenia, or clinical depression? *

Do you use drugs? *

Do you smoke? *

Do you own or have access to a car? *

Are you on any of the following birth control medications: Mirena IUD, Depo Shot, Implanon? *

Have you ever been diagnosed with bi-polar, schizophrenia, or clinical depression? *

Please choose a pseudonym for your profile

First Name

Last Name

Email Address *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Social Security NumberDon't worry your information is confidential and protected

How did you hear about us?

Date of Birth

Height

Weight

Body Type

Complexion

Hair texture

Hair Color

Red/AuburnBlackBlondeBrown

Eye Color

BlueBrownGreenHazel

Maternal Heritage

Paternal Heritage

Blood Type

Marital Status

Religious Affiliation

What was your favorite subject in school and why?

Do you speak any other languages?

SAT Score

ACT Score

High School GPA

If you have over a 3.8 GPA, went to (or are going to) an exceptional university, have received academic scholarships, or have above a bachelor's degree, please check this box

Yes

What college(s) or university(ies) have you attended?

Please list any/all awards, honors or scholarships you have won:

Do you have any artistic abilities? Please List

Do you have any athletic abilities? Please list

What is your current occupation?

What were your previous occupations?

Please describe your personality

Are you right or left handed?

Do you consider yourself introverted or extroverted?

Who do you live with?

Do you have a significant other? Is so, tell us how you met:

What are your hobbies?

Describe your perfect day

Who is your hero and why?

What famous actress would you play in a movie and why?

What would you say is your biggest accomplishment in your life thus far?

What do you hope to accomplish in your life in years to come?

If you could meet anyone in the world, who would it be and why?

Tell us about your most favorite vacation

If you could travel anywhere, where would it be and why?

What would you say is your biggest talent?

Anything we have not asked?

Do you wear or have you worn eyeglasses?

Are you willing to travel 5-10 days for your donation?

Have you worn braces?

Why do you want to become a donor?

How long have you been thinking about it?

Being a donor is a big responsibility which requires going to several doctor's appointments, taking injections and having minor out-patient surgery. Our office, the doctor's office, and your intended parent(s) will count on you to be responsible throughout the entire cycle. Do you feel prepared to commit to this process?

How do your friends and family feel about your decision?

Would you still be able to commit to the process if your friends or family did not want you to be a donor?

What would you like to say to the intended parents who choose you to be their donor?

Not all Intended Parents are able to afford a traditional donor cycle, so in order to save money we have a "Donor-Share" program that helps 2-3 families at the same time. Are you willing to participate in this program?

Would you be willing to freeze a cycle of eggs for one or more families to use in the future?

Seek Submit Surrogacy strongly believes all loving and able couples or individuals deserve the chance to be parents regardless of sexual preference, marital status, ethinicity or sex of the egg recipient. Are you open to being matched with all types of families?

Based on years of research, mental health professionals are encouraging donors and intended parents to have a more open relationship for the sake of the children born through egg donation. Eggsclusive Partners strongly encourages open relationships between egg donors and intended parents. If they request it, are you willing to meet your intended parents?

Are you open to meeting the child in the future if that is requested?

Are you open to exchanging future contact information with your intended Parents(s)?

What were you like as a child?

What were you like as a teenager?

Where did you grow up?

How would you describe your family life when growing up?

Do you have any siblings? If so, tell us about each of them

Do you have any children? If so, tell us about each of them

Biological Father Eye Color

Biological Father Hair Color

Biological Father Educational Level

Is Your Biological Father Deceased

Biological Father Occupation

Biological Mother Hair Color

Biological Mother Eye Color

Biological Mother Educational Level

Is Your Biological Mother Deceased

Biological Mother Occupation

Biological Grandmother Hair Color

Biological Grandmother Eye Color

Biological Grandmother Educational Level

Is Your Biological Grandmother Deceased

Biological Grandmother Occupation

Biological Grandfather Hair Color

Biological Grandfather Eye Color

Biological Grandfather Educational Level

Is Your Biological Grandfather Deceased

Biological Grandfather Occupation

Biological Brother Hair Color

Biological Brother Eye Color

Biological Brother Educational Level

Is Your Biological Brother Deceased

Biological Brother Occupation

Biological Sister Hair Color

Biological Sister Eye Color

Biological Sister Educational Level

Is Your Biological Sister Deceased

Biological Sister Occupation

Biological Sibling Hair Color

Biological Sibling Eye Color

Biological Sibling Educational Level

Is Your Biological Sibling Deceased

Biological Sibling Occupation

Any past or current medical problems (including surgeries, accidents, birth defects, depression, etc.)?

If so please list

Do you drink alcohol?

If yes, how many drinks per week?

Have you ever been pregnant?

If yes, what was the outcome?

Have you ever been a donor before?

If yes, did a pregnancy occur?

Are you currently taking any medication (for physical or mental health)?

If yes, what medications are you on and why?

Are you taking any recreational drugs?

If yes, what are you taking?

Do you smoke?

If yes, since when and how frequent?

Are your menstrual cycles regular?

If no, please explain

Note: Medical history will be verified. Anything purposefully omitted may result in being dropped from the program. If any of the following has occurred in your family, please list which family member and explain:

AcknowledgedPlease acknowledge by checking the box

Condition: Cancer

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Mental Retardation

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Autism Asperger's

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Paralysis or crippling disorders

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Paralysis or crippling disorders

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Alcohol or Drug Addiction

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Cystic Fibrosis

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Sickle Cell Anemia

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Lupus

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Miscarriages, still births, or neonatal deaths

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Miscarriages, still births, or neonatal deaths

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: High blood pressure, heart attacks or strokes

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Memory loss or dementia

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Osteoporosis

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Arthritis

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Allergies

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Blood diseases

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Diabetes (Specifically Type 1 or Type 2)

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Thyroid issues

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Learning disabilities

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Seizure or epilepsy

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Depression

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Panic attacks

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Schizophrenia

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Bipolar Disorder

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: ADD or ADHD

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Age-related issues

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Kidney problems / diseases

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Reproductive problems: i.e. endometriosis, hysterectomies, late-term miscarriages, etc.

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Condition: Vision/Sight/Eye Problems.

To Whom?

Are They Deceased

Age of onset/medication

Age at the time of passing

Please describe any medical or other issues. Other (Any medical issues we've not listed above please explain here):

What kind of birth control are you on?

Please upload up to 10 photos and include current face close ups, current full body and childhood photos. *

What We Are Looking For

Please Complete The Form & Submit