Thank you for your interest in becoming an egg donor for GS Moms. Please fill out the screening form below and we will get back to you as quickly as we can.
Code Name (select a female name followed by 3 numbers)
First Name
Last Name
Email Address
Have you ever been convicted of a crime? YesNo
Are you adopted? YesNo
Can provide a full genetic history? YesNo
Do you have any sexually transmitted diseases? YesNo
Do you think you could pass a psychological examination? YesNo
Are you willing to take a drug test, complete a psychological evaluation, and attend 5-10 local appointments for screening and monitoring? YesNo
Have you given egg donation a lot of thought and consideration? YesNo
Have you researched and understand the risks involved with egg donation? YesNo
I will return all phone calls, texts and emails from GS Moms within 24 hours. YesNo
Birth Date
Address
What is the nearest city to you?
What is your home phone number?
What is your cell phone number?
Is your cell phone a smart phone? YesNo
What is the lowest fee you are willing to take for your first egg donation between $3,500 and $10,000?
Please list a code name that you will be known as during the process
What kind of relationship would you like to have with the parents?
Are you willing to report any new health issues that you may have in the future to the attorney of the recipients? YesNo
Have you donated eggs before? YesNo
Have you used antidepressants within the last year? YesNo
Have you smoked tobacco within the last year? YesNo
Are you still smoking? YesNo
If so, how many cigarettes do you typically smoke a week?
If not, when did you quit?
How many cigarettes a day were you smoking before you quit?
Have you ever been pregnant? YesNo
What kind of birth control are you using?
Have you seen a doctor in the past year for any reason? YesNo
Please list the dates and reasons you have visited a doctor in the last year
Have you ever been hospitalized for substance abuse, depression, or any other psychological problem? YesNo
Please describe
Do you have a major credit card? YesNo
Height
Weight
What is your relationship status? SingleIn a RelationshipEngagedMarriedDivorced
Partner's name and contact information
Emergency contact information
Are you between the age of 19 and 29? YesNo
How did you hear about GS Moms? FriendWorkSchoolCraigs ListBarefoot StudentSearch EngineOther
If you heard about us on Craigslist or Barefoot Student, what city was that ad posted in?
If you heard about us from your college or university, what school are you attending?
How many children do you have?
Are you currently a student? YesNo
Do you have a degree? If so, please list or let us know where you are at in your studies. Please also provide the college or university name and your current GPA.
Upload a picture of self (.jpg)