Altrui
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Donor Details

First name *
Middle names
Surname *
What would you like to be called?
First name of partner
Surname of partner
Marital status
Maiden name
Place of birth
country
address
town/city
county/state
postcode
email *
landline number
second phone (e.g. work)
mobile
Preferred method and time for contact

Personal characteristics ( Donor )

In order to find recipients with as close a match as possible, it is helpful for us to have some extra information about you

Date of birth * 0 years, 0 months
Height ftin
Weight Stlb
BMI 0.00
Build
Ethnicity
Fathers ethnicity
Mothers ethnicity
Skin tone
Eye colour
Hair colour
Hair type

Profile

Occupation / profession
Education / qualifications
Interests / hobbies
How would you describe your personality?
Do you have a criminal record?

Appeal

How did you hear about Altrui?
Source details
Reason for donating
How supportive is your partner or family?

Family History

What children do you have?
Gender Age
Have you finished your family?
Method of contraception
Other

Health

What is your general health
What are your smoking habits
What are your drinking habits
Do you take any therapeutic or recreational drugs?
Please give details
Are you adopted?
Have you had any mental health issues?
Any history of genetic or inherited abnormalities?
History of fertility treatments

GP

GP's name
country
address
town/city
county/state
postcode
landline number

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