Health Information (Please Answer Y

Health Information (Please Answer Yes or No, if yes give details)


Do you have any allergies (if yes give details)?


Do you have any current or past illness (if yes give details)?


Are you currently taking any prescription medications, if yes please give details?


Have you ever had any surgery, if yes please give details?


Do you wear corrective lenses?


How is your vision?




Do you have any hearing impairments?


Do you smoke?
Yes
No
If yes, how much & for how long?


Do you drink alcohol, if yes how much and how often?


Reproductive History:

Have you ever Donated eggs Before ?


Donations 1st 2nd 3rd 4th
No. of Eggs
Successful pregnancy

Is there a History of twins in your family?


Do you have a regular menstrual cycle?


Have you ever been pregnant, if so what was the outcome?


Are you on birth control? Which type?

ผลลัพธ์ (อังกฤษ) 2:

Health Information (Please Answer Yes or No, if Yes give Details) Do You have any allergies (if Yes give Details)? Do You have any current or Past illness (if Yes give Details)? Are You currently taking any prescription Medications, if. Yes please give Details? Have You Ever had any Surgery, if Yes please give Details? Do You Wear corrective Lenses? How is your Vision? Do You have any Hearing impairments? Do You Smoke? Yes No If Yes, How much & for How. long? Do You Drink alcohol, if Yes How much and How often? Reproductive History: Have You Ever Before Donated Eggs? Donations 1st 2nd 3rd 4th No. Eggs of Successful Pregnancy Is there a History of Twins in your Family? Do You have a regular menstrual Cycle? Have You Ever been pregnant, if so what was the outcome? Are You on birth Control? Which type?

ผลลัพธ์ (อังกฤษ) 3:

Health Information (Please Answer Yes or No if yes, give details)


Do you have any allergies (if yes give details)?


Do. You have any current or past illness (if yes give details)?


Are you currently taking any, prescription medications if. Yes please give details?


Have you ever had any surgery if yes, please give details?


Do you wear corrective lenses??


How is your vision?




.Do you have any hearing impairments?


Do you smoke?
Yes

If, No yes how much & for how long?


Do you, drink alcohol. If yes how much and how often?




Reproductive History Have you ever Donated eggs Before?


Donations 1st 2nd 3rd 4th
No.? Of Eggs
Successful pregnancy

Is there a History of twins in your family?


Do you have a regular menstrual cycle?


.Have you ever, been pregnant if so what was the outcome?


Are you on birth control? Which type?
.