Reminder: Our office will be closed February 18th in observance of President's Day. Please consider this when placing your order, no shipments will go out on the 18th. Thank you!
Playing sports, volunteering, spending time with family, and scrap-booking.
Education Status: High School Diploma Obtained
Area of Study: Human Resource Management
Vision: Good, does wear lenses
Hearing: Excellent
Dentition: Good, no orthodontia required
Allergies: None known
Hospitalization: None known
Alcohol Usage: Does not drink alcohol
Tobacco Usage: Does not smoke
Drug Usage: Tests NEGATIVE for Drugs of Abuse.
Paternal Grandfather: Alive and in his 80's, Healthy
Paternal Grandmother: Alive and in her 80's, Healthy
Maternal Grandfather: Died in his 80's, Pneumonia
Maternal Grandmother: Alive and in her 70's, Healthy
Father: Alive and in his 40's, Healthy
Mother: Alive and in her 40's, Migraines (treated with ibuprofen), rheumatoid arthritis in her 40s
Siblings: At least one sibling, all in good health.
Genetic Screening Performed: Yes
Donor Communication (Type): Open
Limited Available? No
Past Pregnancy: Yes
Face: Oval shape with two small moles on right cheek
Lips: Full upper and lower lips
Nose: Longer than average in length with slightly wider rounded tip
Ears: Larger in size, partially attached lobes, not tucked back
Eyes: Round almond shape, medium size, average set, with medium length eye lashes
Eyebrows: Medium fullness, curved
Summary: Very sweet girl, and very much on top of things! She always strives to be ahead of the game and seems to be very proactive in every aspect of life. This donor has been tested for BRCA1 and BRCA2 with negative results for both.
Have you or any member of your family (by blood), had a problem or defect at birth of any of the following body systems?
Relative | Problem at birth: Bones, muscles, joints, limbs |
Problem at birth: Gastrointestinal system |
Problem at birth: Nervous system, brain, spinal cord |
Problem at birth: Blood circulatory system |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Have you or any member of your family (by blood), had a problem or defect at birth of any of the following body systems?
Relative | Problem at birth: Breathing, respiratory system |
Problem at birth: Heart |
Problem at birth: Other organs |
Problem at birth: Genital, urinary, reproductive |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Have you or any member of your family (by blood), had a problem or defect at birth of any of the following body systems?
Relative | Problem at birth: Metabolic |
Problem at birth: Learning disabilities |
Problem at birth: Other |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Sister 1: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Maternal Aunt 4: | |||
Maternal Uncle 1: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Maternal Cousin 7: | |||
Maternal Cousin 8: | |||
Maternal Cousin 9: | |||
Maternal Cousin 10: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: |
Relative | Heart Attack (age of onset) |
Heart Disease (age of onset) |
High Blood Pressure (age of onset) |
Arrhythmia (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Stroke (age of onset) |
TIA (Mini Stroke) (age of onset) |
Aneurism (age of onset) |
Other Heart/Vascular Disorder (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Anemia (age of onset) |
Sickle Cell (age of onset) |
Hemophilia (age of onset) |
Leukemia (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | 30's | |||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Immune Problems (age of onset) |
Other Blood Disorder (age of onset & disorder) |
---|---|---|
Self | ||
Mother | ||
Father | ||
Sister 1: | ||
Maternal Grandmother | ||
Maternal Grandfather | ||
Paternal Grandmother | ||
Paternal Grandfather | ||
Maternal Aunt 1: | ||
Maternal Aunt 2: | ||
Maternal Aunt 3: | ||
Maternal Aunt 4: | ||
Maternal Uncle 1: | ||
Paternal Aunt 1: | ||
Paternal Aunt 2: | ||
Maternal Cousin 1: | ||
Maternal Cousin 2: | ||
Maternal Cousin 3: | ||
Maternal Cousin 4: | ||
Maternal Cousin 5: | ||
Maternal Cousin 6: | ||
Maternal Cousin 7: | ||
Maternal Cousin 8: | ||
Maternal Cousin 9: | ||
Maternal Cousin 10: | ||
Paternal Cousin 1: | ||
Paternal Cousin 2: | ||
Paternal Cousin 3: | ||
Paternal Cousin 4: |
Relative | Hay Fever (age of onset) |
Asthma (age of onset) |
Emphysema (age of onset) |
Tuberculosis (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Lung Cancer (age of onset) |
Pneumonia (age of onset) |
Other Respiratory Disorder (age of onset & disorder) |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Sister 1: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Maternal Aunt 4: | |||
Maternal Uncle 1: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Maternal Cousin 7: | |||
Maternal Cousin 8: | |||
Maternal Cousin 9: | |||
Maternal Cousin 10: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: |
Relative | Ulcers (age of onset) |
Gall Stones (age of onset) |
Hepatitis A (age of onset) |
Hepatitis B (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Other Liver Disease (age of onset) |
Colon Cancer (age of onset) |
Ulcerative Colitis (age of onset) |
Crohn's Disease (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Cystic Fibrosis (age of onset) |
Intestinal Cancer (age of onset) |
Other Gastro-Intestinal Disorder (age of onset & disorder) |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Sister 1: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Maternal Aunt 4: | |||
Maternal Uncle 1: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Maternal Cousin 7: | |||
Maternal Cousin 8: | |||
Maternal Cousin 9: | |||
Maternal Cousin 10: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: |
Relative | Diabetes (age of onset) |
Hypoglycemia (age of onset) |
Thyroid Cancer (age of onset) |
Thyroid Disease (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Goiter (age of onset) |
Adrenal Disorder (age of onset) |
Hyperactivity (age of onset) |
Other Metabolic/Endocrine Disorder (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Kidney Disease (age of onset) |
Disease of Ureter, Bladder, Urethra (age of onset) |
Rectal Disorder (age of onset) |
Other Urinary Disorder (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Undescended Testicle(s) (age of onset) |
Hypospadiasis (age of onset) |
HPV/Genital Warts (age of onset) |
Genital Herpes (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Prostate Cancer (age of onset) |
Uterine Fibroids (age of onset) |
Ovarian Cysts (age of onset) |
Cancer of the Cervix (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Cancer of the Uterus (age of onset) |
Varicocele | Other Genital/Reproductive Disorder (age of onset & disorder) |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Sister 1: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Maternal Aunt 4: | |||
Maternal Uncle 1: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Maternal Cousin 7: | |||
Maternal Cousin 8: | |||
Maternal Cousin 9: | |||
Maternal Cousin 10: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: |
Relative | Acne (age of onset) |
Scarring Acne (age of onset) |
Eczema (age of onset) |
Psoriasis (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | Teens | |||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Skin Cancer (age of onset) |
Pigmentation Disorders (age of onset) |
Other Skin Disorder (age of onset & disorder) |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Sister 1: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Maternal Aunt 4: | |||
Maternal Uncle 1: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Maternal Cousin 7: | |||
Maternal Cousin 8: | |||
Maternal Cousin 9: | |||
Maternal Cousin 10: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: |
Relative | Migraines (age of onset) |
Mental Retardation (age of onset) |
Alzheimers (age of onset) |
Multiple Sclerosis (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | 40's | |||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Cerebral Palsey (age of onset) |
Epilepsy (age of onset) |
Hydrocephalus (age of onset) |
Spinal Cord Disorder (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Huntington's Chorea (age of onset) |
Gaucher's Disease (age of onset) |
Wilson's Disease (age of onset) |
Other Neurological Disorder (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Schizophrenia (age of onset) |
Manic Depression (age of onset) |
Clinical Depression (age of onset) |
Other Mental Health Disorder (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Muscular Dystrophy (age of onset) |
Other Chronic Muscle Disease (age of onset & disorder) |
Lupus (age of onset) |
Deformity of Spine (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Osteoporosis (age of onset) |
Dwarfism (age of onset) |
Arthritis (age of onset) |
Gout (age of onset) |
---|---|---|---|---|
Self |
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Mother |
40's |
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Father |
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Sister 1: |
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Maternal Grandmother |
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Maternal Grandfather |
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Paternal Grandmother |
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Paternal Grandfather |
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Maternal Aunt 1: |
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Maternal Aunt 2: |
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Maternal Aunt 3: |
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Maternal Aunt 4: |
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Maternal Uncle 1: |
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Paternal Aunt 1: |
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Paternal Aunt 2: |
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Maternal Cousin 1: |
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Maternal Cousin 2: |
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Maternal Cousin 3: |
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Maternal Cousin 4: |
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Maternal Cousin 5: |
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Maternal Cousin 6: |
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Maternal Cousin 7: |
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Maternal Cousin 8: |
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Maternal Cousin 9: |
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Maternal Cousin 10: |
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Paternal Cousin 1: |
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Paternal Cousin 2: |
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Paternal Cousin 3: |
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Paternal Cousin 4: |
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Relative | Myasthenia Gravis (age of onset) |
Other Muscle/Bone/Joint Disorder (age of onset & disorder) |
---|---|---|
Self | ||
Mother | ||
Father | ||
Sister 1: | ||
Maternal Grandmother | ||
Maternal Grandfather | ||
Paternal Grandmother | ||
Paternal Grandfather | ||
Maternal Aunt 1: | ||
Maternal Aunt 2: | ||
Maternal Aunt 3: | ||
Maternal Aunt 4: | ||
Maternal Uncle 1: | ||
Paternal Aunt 1: | ||
Paternal Aunt 2: | ||
Maternal Cousin 1: | ||
Maternal Cousin 2: | ||
Maternal Cousin 3: | ||
Maternal Cousin 4: | ||
Maternal Cousin 5: | ||
Maternal Cousin 6: | ||
Maternal Cousin 7: | ||
Maternal Cousin 8: | ||
Maternal Cousin 9: | ||
Maternal Cousin 10: | ||
Paternal Cousin 1: | ||
Paternal Cousin 2: | ||
Paternal Cousin 3: | ||
Paternal Cousin 4: |
Relative | Deafness before age 60 (age of onset) |
Deformity of the Ear (age of onset) |
Cataracts before age 50 (age of onset) |
Blindness (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Color Blindness (age of onset) |
Glaucoma (age of onset) |
Deviated Septum (age of onset) |
Sinusitis (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |
Relative | Other Sight/Hearing/Olfactory Disorder (age of onset & disorder) |
---|---|
Self | |
Mother | |
Father | |
Sister 1: | |
Maternal Grandmother | |
Maternal Grandfather | |
Paternal Grandmother | |
Paternal Grandfather | |
Maternal Aunt 1: | |
Maternal Aunt 2: | |
Maternal Aunt 3: | |
Maternal Aunt 4: | |
Maternal Uncle 1: | |
Paternal Aunt 1: | |
Paternal Aunt 2: | |
Maternal Cousin 1: | |
Maternal Cousin 2: | |
Maternal Cousin 3: | |
Maternal Cousin 4: | |
Maternal Cousin 5: | |
Maternal Cousin 6: | |
Maternal Cousin 7: | |
Maternal Cousin 8: | |
Maternal Cousin 9: | |
Maternal Cousin 10: | |
Paternal Cousin 1: | |
Paternal Cousin 2: | |
Paternal Cousin 3: | |
Paternal Cousin 4: |
Relative | Alcoholism (age of onset) |
Drug Abuse or Addiction (age of onset) |
Smoker/Tobacco Use (age of onset) |
---|---|---|---|
Self | |||
Mother | 30's | ||
Father | |||
Sister 1: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Maternal Aunt 4: | |||
Maternal Uncle 1: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Maternal Cousin 7: | |||
Maternal Cousin 8: | |||
Maternal Cousin 9: | |||
Maternal Cousin 10: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: |
Relative | Oral Herpes/Cold Sores (age of onset) |
Other Disorder (age of onset & disorder) |
Breast Cancer (age of onset) |
Any Other Cancer (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | 30's | |||
Maternal Aunt 3: | ||||
Maternal Aunt 4: | ||||
Maternal Uncle 1: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Maternal Cousin 7: | ||||
Maternal Cousin 8: | ||||
Maternal Cousin 9: | ||||
Maternal Cousin 10: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: |