立即線上諮詢 立即填寫表單 或是點選下方按鈕諮詢 立即線上諮詢 Please enable JavaScript in your browser to complete this form.護照中文名 Chinese Name 護照英文名 English Name *FirstLast手機號碼 Phone Number *Line ID 請先加客服Line ID: @613zzibu客服將一對一確認您的申請表喔!Instagram 帳號( 僅做補充生活照使用)Email (若客服聯繫不上將以email通知) *生日 DOB : mm/dd/yyyy *身高Height (cm) *體重 Weight (kg) *職業 Job *血型Blood Type *A型B型O型AB型不清楚血型是否有捐過卵 Donate Egg Experience *Yes 是No否有海外捐卵經驗者,請告知取卵國家診所日期、取卵數Previous egg donation results *可以待在美國14-16天嗎?Can stay in USA 14-16 days ? *可以不可以最高學歷及科系-高中/大學/碩士 Highest Diploma and Major *目前居住地(海外請填寫國家及預計返台時間) Residency *父親的年齡/身高/職業/種族/教育/健康狀況(若過世需填原因) *如52/178/公務員/漢族/大學/健康母親的年齡/身高/職業/種族/教育/健康狀況(若過世需填原因) *如52/178/公務員/漢族/大學/健康祖父的年齡/身高/職業/種族/教育/健康狀況(若過世需填原因) *如52/178/公務員/漢族/大學/健康祖母的年齡/身高/職業/種族/教育/健康狀況(若過世需填原因) *如52/178/公務員/漢族/大學/健康外祖父的年齡/身高/職業/種族/教育/健康狀況(若過世需填原因) *如52/178/公務員/漢族/大學/健康外祖母的年齡/身高/職業/種族/教育/健康狀況(若過世需填原因) *如52/178/公務員/漢族/大學/健康國籍Nationality *族群 Races *漢族(Han Chinese)華裔(Ethnic Chinese)客家(Hakka)閩南(Minnan / Southern Fujian)越南裔(Vietnamese)韓裔(Korean)日裔(Japanese)泰裔(Thai)馬來裔(Malay)印度裔(Indian)白人(Caucasian / European descent)斯拉夫裔(Slavic)北歐裔(Scandinavian)拉丁裔(Latin European,如西班牙、義大利)拉丁美洲裔(Latina / Hispanic)非裔美國人(African American)原住民(Native American)非洲裔(African descent)北非裔(North African / Arab)華裔混血(Chinese + Other)白人混血(Caucasian + Other)猶太裔(Jewish)中亞裔(Kazakh, Kyrgyz, Uzbek)阿拉伯裔(Arab)其他(請註明)原始髮色Hair Color *黑色Black深棕色Dark Brown棕色Brown淺棕色Light Brown金色Blonde紅色Red / Auburn灰白色Grey / White染髮Dyed (please specify)眼珠顏色Eyeball Color *黑色Black深棕色Dark Brown棕色Brown淺棕色Light Brown藍色Blue綠色Green灰色Gray混色Mixed / Hazel原始髮質Natural Hair *直髮Straight捲髮 Curly波浪髮 Wave上傳五官清晰半身照8-10張(小於5MB) Upload 8–10 clear upper-body photos (under 5MB each) *請淡妝,勿使用放大片、戴口罩、墨鏡, 需看清楚單雙眼皮、眼型、鼻子、耳朵。 Please wear light makeup. Do not wear colored contact lenses, face masks, or sunglasses. Facial features must be clearly visible, including eyelid type (single or double eyelids), eye shape, nose, and ears.上傳童年照1-5張(小於5MB) Upload 1–5 childhood photos (under 5MB each) *幼兒、國小、國中、、高中畢業照皆可 Photos from toddler, elementary school, junior high, or high school graduation are all acceptable.上傳全身照5-10張(小於5MB) Upload 5–10 full-body photos (under 5MB each) *需看身高體重比例 Photos should clearly show your body shape to help assess your BMI (Body Mass Index).Please wear fitted but appropriate clothing. Most clinics require egg donors to have a BMI between 18 and 29.If you're unsure of your BMI, you can use an online BMI calculator.上傳捐卵報告、基因報告、檢查報告 Egg donation report , Genetic test report ,Medical examination report ,Egg donation report , Genetic test report ,Medical examination report ,Highest education diploma , Academic transcript, Other award certificates最近2次的月經時間、預計下次的月經時間Dates of your last two menstrual periods, Expected date of your next period *(月經第3天做陰道超音坡及抽血賀爾蒙檢查)請加入Line官方帳號@613zzibu客服將與您聯繫 *已加入Added尚未加入 Not added yetAdd Line Official Account and our customer service will contact you送出Submit