Egg Donor – Divine Gift Surrogacy Limited

First Name*

Last Name

House Address

City

Region

Date of Birth

Contact Phone*

Contact Email

Occupation

Ethnicity

Educational Background. Please list your educational history starting with the most recent.

Your Height

Your Weight

Blood Type (if known): Please specify your blood type and Rh faction if available

Known Allergies

Current Medication

Family History (Mother, Father, and All Siblings)

Previous Pregnancies and childbirth Details: If you have not had any children, please write N/A: If you have had children, please provide details for each child, including their age, gender, method of delivery (e.g. vaginal, c-section), gestation period (in weeks) and current health status.

Reproductive Disorders (if any):

Menstrual cycle Regulations and Associated Symptoms

Have you previously participated in egg donation? If yes, please provide the number of times you’re donated and any relevant details about the donation(s)

Smoking Status:

I do not smoke

I smoke occasionally

I smoke regularly.

Alcohol consumption

I do not consume alcohol

I drink alcohol occasionally (Socially)

I drink alcohol regularly.

Recreational Drug use:

I do not use recreational drugs

I use recreational drugs occasionally

I use recreational drugs regularly.

Is there anything you would like to share with the intended parents? Feel free to provide a personal message, your motivations for becoming a donor or any thoughts and well-wishes you have for them.

Would you be willing to share a few recent photographs of yourself? These images can significantly help the intended parents establish a more personal connection. We ask that the photos you provide are clear and offer a good representative of your appearance. If you choose “Yes”, our agency staff will reach out to you to collect the pictures.

Yes

No

Consent and Acknowledge: In order to proceed with your application to become an egg donor at Divine Gift Surrogacy Limited, you must agree to the following consents and acknowledgements. Please read each statement thoroughly. By selecting all three options below, you confirm your understanding and agreement with this term:

* Information Sharing and Release: By submitting this Egg Donor Application Form with my electronic signature, I consent to sharing my personal and medical information with Divine Gift Surrogacy Limited. I authorize the agency to release this information to intended parents and their designated IVF Clinics for the purpose of screening in the egg donation process. I understand the importance of this step in ensuring the suitability and safety for all parties involved. I am fully aware of my right, which include confidentiality and protection of my medical records. I confirm that all information provided in this application is true and accurate to the best of my knowledge. I acknowledge that I have the right to withdraw this authorization at anytime by submitting a written notice to Divine Gift Surrogacy Limited, with the understanding that withdrawal will not affect any prior actions taken or information released before receiving my notice.

* Agency Representation and Relationship with IVF Clinics and or intended Parents: As an egg donor associated with Divine Gift Surrogacy Limited, I agree to the terms of exclusive representation arrangements made through the agency. The exclusivity applies specifically to engagements with IVF Clinics and Intended parents introduced by Divine Gift Surrogacy Limited, I will not independently contact or arrange egg donations with these parties or IVF Clinics while represented by Divine Gift Surrogacy Limited. However, this agreement is limited to connections made through the agency, and I retain the freedom to pursue egg donation opportunities outside of this network, with IVF Clinics or intended parents not affiliated with Divine Gift Surrogacy Limited. This ensures a balance between the managed processes of Divine Gift Surrogacy Limited, and my independence to explore other egg donation avenues.

Liability and Risks: I release Divine Gift Surrogacy Limited, its directors, and employees from any liabilities and acknowledge the inherent risks associated with egg donation. While the agency assists in screening and introducing intended parents and designated IVF Clinics, the final decision to donate egg to any particular parties and to proceed with the egg donation process lies with me, based on my judgement and preferences. By agreeing to this, I waive any claims against Divine Gift Surrogacy Limited, its directors, and employees related to the egg donation process, affirming my understanding and acceptance of the involved risks and responsibilities.

I consent and Acknowledge all the above

For Egg Donors

At the core of our egg donor program lies a profound appreciation and reverence for the remarkable dedication of our donors.

Join our Egg Donor Program at Divine Gift Surrogacy

Egg Donor Application Medical and Family History Form.

Get notified by subscribing our newsletter