立即在线咨询 立即填写 或是点选下方按钮咨询 立即在线咨询 请在浏览器中启用JavaScript来完成此表单。护照中文名 Chinese Name 护照英文名 English Name *前一页后一页手机号码 Phone Number *Line ID 请先加客服Line ID: @613zzibu客服将一对一确认您的申请表喔!Instagram 账号( 仅做补充生活照使用)Email (若客服联系不上将以email通知) *生日 DOB : mm/dd/yyyy *身高Height (cm) *体重 Weight (kg) *职业 Job *血型Blood Type *A型B型O型AB型不清楚血型是否有捐过卵 Donate Egg Experience *Yes 是No否有海外捐卵经验者,请告知取卵国家诊所日期、取卵数Previous egg donation results *可以待在美国14-16天吗?Can stay in USA 14-16 days ? *可以不可以最高学历及科系-高中/大学/硕士 Highest Diploma and Major *目前居住地(海外请填写国家及预计返台时间) Residency *父亲的年龄/身高/职业/种族/教育/健康状况(若过世需填原因) *如52/178/公务员/汉族/大学/健康母亲的年龄/身高/职业/种族/教育/健康状况(若过世需填原因) *如52/178/公务员/汉族/大学/健康祖父的年龄/身高/职业/种族/教育/健康状况(若过世需填原因) *如52/178/公务员/汉族/大学/健康祖母的年龄/身高/职业/种族/教育/健康状况(若过世需填原因) *如52/178/公务员/汉族/大学/健康外祖父的年龄/身高/职业/种族/教育/健康状况(若过世需填原因) *如52/178/公务员/汉族/大学/健康外祖母的年龄/身高/职业/种族/教育/健康状况(若过世需填原因) *如52/178/公务员/汉族/大学/健康国籍Nationality *族群 Races *汉族(Han Chinese)华裔(Ethnic Chinese)客家(Hakka)闽南(Minnan / Southern Fujian)越南裔(Vietnamese)韩裔(Korean)日裔(Japanese)泰裔(Thai)马来裔(Malay)印度裔(Indian)白人(Caucasian / European descent)斯拉夫裔(Slavic)北欧裔(Scandinavian)拉丁裔(Latin European,如西班牙、意大利)拉丁美洲裔(Latina / Hispanic)非裔美国人(African American)原住民(Native American)非洲裔(African descent)北非裔(North African / Arab)华裔混血(Chinese + Other)白人混血(Caucasian + Other)犹太裔(Jewish)中亚裔(Kazakh, Kyrgyz, Uzbek)阿拉伯裔(Arab)其他(请注明)原始发色Hair Color *黑色Black深棕色Dark Brown棕色Brown浅棕色Light Brown金色Blonde红色Red / Auburn灰白色Grey / White染发Dyed (please specify)眼珠颜色Eyeball Color *黑色Black深棕色Dark Brown棕色Brown浅棕色Light Brown蓝色Blue绿色Green灰色Gray混色Mixed / Hazel原始发质Natural Hair *直发Straight卷发 Curly波浪发 Wave上传五官清晰半身照8-10张(小于5MB) Upload 8–10 clear upper-body photos (under 5MB each) *请淡妆,勿使用放大片、戴口罩、墨镜, 需看清楚单双眼皮、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.上传童年照1-5张(小于5MB) Upload 1–5 childhood photos (under 5MB each) *幼儿、国小、国中、、高中毕业照皆可 Photos from toddler, elementary school, junior high, or high school graduation are all acceptable.上传全身照5-10张(小于5MB) Upload 5–10 full-body photos (under 5MB each) *需看身高体重比例 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.上传捐卵报告、基因报告、检查报告 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次的月经时间、预计下次的月经时间Dates of your last two menstrual periods, Expected date of your next period *(月经第3天做阴道超音坡及抽血贺尔蒙检查)请加入Line官方账号@613zzibu客服将与您联系 *已加入Added尚未加入 Not added yetAdd Line Official Account and our customer service will contact you送出Submit