EN_ΘΕΛΩ ΝΑ ΓΙΝΩ ΔΟΤΡΙΑ ΩΑΡΙΩΝ

Questionnaire

Please answer the questions below so that we can get to know you better. They will help us get the necessary information about you before proceeding with the required tests, medical history, documents, etc.
Name: *

Name Surname
Date of birth (you must be 18 - 32 years old): *

Day Month Year
Mobile phone number: *
In case you want us to call you on a specific day and time please note:
E-mail: *
Address: *
Profession:
Nationality: *
Skin colour: *
Hair colour: *
Eye colour: *
Height: *
Weight: *
Are you familiar with the process of donating eggs? Have you ever been a donor? *

Yes No
Do you have children? *

Yes No
Do you have a regular period? *

Yes No
Are you taking any medicine/s? *

Yes No
If you are taking any medicine(s), please note:
Do you have some kind of anemia? *

Yes No I don't know
Do you have any health problem? *

Yes No
If any, please mention:
Have you had any surgeries and if so, which ones?
Who introduced you to us?
*

I have been fully informed about the privacy policy of Medimall Clinic (www.medimall.gr) and I consent to the management of the information I have voluntarily filled in.
Should be Empty:

Questionnaire