Welcome to our Egg Donor Program


Thank you so much for considering egg donation to help women who are battling infertility. You are truly a special person and the only hope for so many women in need of donor eggs in order to conceive a child of their own.

The application form, which you will complete below, is the last step before we welcome you as an eggceptional egg donor!

Should you have any questions, please feel free to contact Linda, your egg donor “mother”.

Linda is available to you via WhatsApp, Calls or Email Now & forever whilst you are an egg donor, as she has been for 100’s of donors over the past 10 years!

WHATSAPP 066 22 55 003

EMAIL linda@capefertility.co.za

Please note that the application form will remember your data each time you click on the “Next” button. This makes for a more convenient way to fill in the form where you can complete one page at a time. That way you don’t have to fill in the full form in one go.

Our application form can be completed on your computer AND on your cell phone for your convenience.

Page 1 of 12

For Office Use Only

This section completed on page 1 & 2 is never shared with anyone outside of our clinic medical staff.

Please provided us with a recent adult head and shoulders picture of yourself. This is ONLY for office identification & never shared with any recipients. You may upload the photo or email it to us.

Very Important! - If you do not know please get measured

Very Important! - If you do not know please get weighed

Please note that your husband needs to give his consent for to you to donate your eggs.

Please be advised that you may only donate after 6 months post the birth

Thank you for completing the personal confidential information.
Please click on NEXT to start the last step which is completing your personal Egg Donor Profile!

Egg Donor Profile

Note when completing your profile: This is the Egg Donor Profile that couples will be given to review. You will be identified to recipients by a number to protect your identity. Your name is never shared with couples.There is no wrong or right way to complete your profile. There is a recipient for every donor so just be your beautiful self 😉 All that matters is that every question is answered and that it is completed with truth. Enjoy writing about how fabulous you are!
Please upload a picture of you as a baby and/or up to age 11 years old. This picture will be added to your profile. Additional pictures are GREAT if you have them, please also upload up to 3 additional pictures below. You can also WhatsApp or SMS childhood pictures to Zaahira on 066 288 7382 or email them to linda@capefertility.co.za (you can also take a photo of your hard copy photographs and send them to us).

Physical Characteristics

Face & Body Shape

Personality & Character

Lifestyle

Education & Employment

 

Family Heritage & Characteristics

Mother

E.g. (South African, Zulu, Dutch, Xhosa, Irish etc

Father
Sibling 1
Sibling 2
Sibling 3
Sibling 4
Maternal Grandmother Maternal meaning your mother's side of the family
Maternal Grandfather
Paternal Grandmother Paternal meaning your father’s side of the family
Paternal Grandfather  

Family Medical Health History

 
Family Health Status  

Genetic Testing

If you are a carrier of the conditions below please indicate by ticking the box. If you do not know please leave blank.

Medical History

Please indicate whether YOU or a FAMILY MEMBER (only biological family) suffer or have suffered from any of the following: * If you do not know, please type Unknown in the field. * If there is any cancer in your family please indicate the type of cancer.

Medical History Continued

Please indicate whether YOU or a FAMILY MEMBER (only biological family) suffer or have suffered from any of the following: * If you do not know, please type Unknown in the field. * If there is any cancer in your family please indicate the type of cancer.

Donors Declaration

Please indicate YES if you are in agreement with each of the statements below.  

 

 

 

Spread the giving!