Munarakudoonori terviseküsimustik

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Telefon(Required)

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Rahvus(Required)

Haridus/amet(Required)

Kas raviarst võib tutvuda Teie digilooga enne vastuvõttu?(Required)

Jah

Teie tunnused:

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Pikkus:(Required)

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Eluviis ja tervis

Miks otsustasite tulla munarakudoonoriks?(Required)

Kas olete varem munarakke loovutanud?(Required)

Kui jah, täpsustage mitu korda

Milline on Teie praegune tervislik seisund?(Required)

Kas tarbite regulaarselt ravimeid (milliseid, loetlege)?(Required)

Kas suitsetate? Kui jah, mitu sigaretti päevas?(Required)

Kas tarbite alkoholi? Mitu korda nädalas/kuus, kogused?(Required)

Narkootikumide tarbimine (kas olete elu jooksul tarbinud, mida, mis koguses, kui pikalt?)(Required)

Millal (mis vanuses) algas esimene menstruatsioon?(Required)

Millist rasestumisvastast vahendit kasutate?(Required)

Kas Teil või Teie lähisugulastel esineb teadaolevalt pärilikke geneetilisi haiguseid?(Required)

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