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!
ICI ?
If you plan to perform an intra-cervical insemination (also known as vaginal insemination) which is the placement of the sperm near, but not inside of the cervix, the ICI preparation is suitable. The insemination may be performed in the privacy of your own home without the assistance of a medical provider, in all states allowing this procedure.
ICI specimens are 'unwashed' and similar to a 'raw' ejaculate which contains natural nutrients, proteins, sperm cells, etc. Unwashed samples are similar to the deposit made during intercourse. https://www.nwcryobank.com/general-sperm-information/ ICI specimens may only be used for an intra-cervical insemination, unless the sample is put through a washing procedure by your medical provider. If the ICI specimen is placed directly into the cervix or the uterus, severe cramping and even shock may occur. Once washed, it may be used for an IUI (intra-uterine insemination) or IVF (In-vitro Fertilization treatment). If you plan to have your medical provider perform your insemination, ask if they prefer you purchase an ICI (unwashed), or an IUI (washed) specimen. Most fertility doctors and/or clinics can wash specimens prior to treatments. Note: If the specimen undergoes additional processing by your clinic prior to insemination, the motility guarantee will be void. |
Less than 12 Remaining |
IUI ?
If you plan to perform an intra-cervical insemination (also known as vaginal insemination) which is the placement of the sperm near, but not inside of the cervix, the IUI preparation is suitable. The insemination may be performed in the privacy of your own home without the assistance of a medical provider, in all states allowing this procedure.
Or, if you plan to have your medical provider perform the insemination, the IUI preparation may be required. It is best to ask if your provider prefers you purchase an ICI (unwashed), or an IUI (washed) specimen. Most fertility doctors and/or clinics can wash specimens prior to treatments. Note: If the specimen undergoes additional processing by your clinic prior to insemination, the motility guarantee will be void. IUI specimens are "washed". The term "washed" means that the "raw" ejaculate is put through a density gradient to remove dead and poorly performing sperm, and other unnecessary contents. This process creates specimens with a high concentration of motile sperm. https://www.nwcryobank.com/general-sperm-information/) |
50+ Remaining |
ICI-IVF ?
ICI-IVF specimens are "unwashed" and similar to a "raw" ejaculate which contains natural nutrients, proteins, sperm cells, etc. Unwashed samples are similar to the deposit made during intercourse. These specimens have a lower sperm count than our standard vial making them suitable for an IVF procedure with a Fertility Clinic or Reproductive Endocrinologist.
These specimens are also suitable for an intra-cervical insemination (also known as vaginal insemination) which is the placement of the sperm near, but not inside of the cervix. The insemination may be performed in the privacy of your own home without the assistance of a medical provider, in all states allowing this procedure. Because the sperm count is lower than our standard vials, it might be advisable to consider purchasing 2 vials for each attempted insemination. ICI specimens may only be used for an intra-cervical insemination, unless the sample is put through a washing procedure by your medical provider. If the ICI specimen is placed directly into the cervix or the uterus, severe cramping and even shock may occur. Once washed, it may be used for an IUI (intra-uterine insemination) or IVF (In-vitro Fertilization treatment). If you plan to have your medical provider perform your insemination, ask if they prefer you purchase an ICI (unwashed), or an IUI (washed) specimen. Most fertility doctors and/or clinics can wash specimens prior to treatments. Note: If the specimen undergoes additional processing by your clinic prior to insemination, the motility guarantee will be void. |
Out of Stock |
IUI-IVF ?
IUI-IVF specimens are "washed". The term "washed" means that the "raw" ejaculate is put through a density gradient to remove dead and poorly performing sperm, and other unnecessary contents. These specimens have a lower sperm count than our standard vial making them suitable for an IVF procedure with a Fertility Clinic or Reproductive Endocrinologist. Note: If the specimen undergoes additional processing by your clinic prior to insemination, the motility guarantee will be void.
These specimens are also suitable for an intra-cervical insemination (also known as vaginal insemination) which is the placement of the sperm near, but not inside of the cervix. The insemination may be performed in the privacy of your own home without the assistance of a medical provider, in all states allowing this procedure. Because the sperm count is lower than our standard vials, it might be advisable to consider purchasing 2 vials for each attempted insemination. |
Out of Stock |
Inventory lists are based on daily inventory counts. The listing does not include orders in progress. Orders will be filled on a first come, first serve basis and inventories may shift as orders process.
Enter the Purchase CenterEnjoys archery and outdoors activities. Very comfortable in a social setting. He loves to play Rugby and continues to get better at playing guitar.
Education Status: Undergraduate Degree Obtained
Area of Study: Anthropology, Business Administration, Sociology
CMV Status (All donors test CMV-IgM Negative): Positive
Vision: Fair, does wear lenses
Hearing: Excellent
Dentition: Excellent, no orthodontia required
Allergies: None known
Hospitalization: None known
Alcohol Usage: Does drink alcohol; 0-3 Drinks per week
Tobacco Usage: Does not smoke
Drug Usage: Tests NEGATIVE for Drugs of Abuse.
Paternal Grandfather: Alive and in his 70's, Healthy
Paternal Grandmother: Alive and in her 60's, Smoker
Maternal Grandfather: Alive and in his 70's, Glaucoma in his 60's, smoker
Maternal Grandmother: Alive and in her 70's, Gout in her 70's, Cataracts 50's
Father: Alive and in his 40's, Smoker
Mother: Alive and in her 40's, Anemia in her 40's, smoker, breast cancer in her 40's
Siblings: at least one sibling and in good health
Genetic Screening Performed: Yes
Donor Communication (Type): Open
Limited Available? No
Past Pregnancy: Yes
Face: Oval shape ending with a prominent chin and dimples when smiling.
Lips: Medium upper lip, medium fullness lower lip.
Nose: Straight, medium in size, Nordic (Anglo-Saxon) style.
Ears: Medium, tucked back, slightly detached lobes.
Eyes: Medium in size, roundish-almond shaped deep set, medium lashes.
Eyebrows: Medium fullness, straight.
Summary: I enjoy conversation with this particular donor as he is a joy to be around. He is engaging and always seems to be listening attentively to what you are saying. This guy is energetic and extremely punctual. When talking to him about his weekends, they are always filled with outdoor adventures and family. His best attribute would be his dimples when he smiles ear to ear.
Information contained in our expanded donor profiles has changed over time and consequently, not every question asked today was asked in previous years. When you see an answer to a question that is N/A, please understand that this was simply a new question that was not asked at the time that particular donor completed his/her application form, and consequently, we are unable to provide a response for that question.
If you are purchasing an expanded profile for a donor listed as "available on-line", the profile will be viewable from your account once we have processed your credit card which is typically 1 business day from the day you place the order. For expanded profiles listed as "available by mail", you can expect to receive those within 3 business days of placing your order.
This donor's expanded profile is available Online.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: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
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: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
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: | |||
Sister 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Uncle 1: | Was almost born backwards but the doctors flipped him around. | ||
Maternal Uncle 2: | |||
Paternal Uncle 1: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: |
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: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
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: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Anemia (age of onset) |
Sickle Cell (age of onset) |
Hemophilia (age of onset) |
Leukemia (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | 40's | |||
Father | ||||
Sister 1: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Immune Problems (age of onset) |
Other Blood Disorder (age of onset & disorder) |
---|---|---|
Self | ||
Mother | ||
Father | ||
Sister 1: | ||
Sister 2: | ||
Maternal Grandmother | ||
Maternal Grandfather | ||
Paternal Grandmother | ||
Paternal Grandfather | ||
Maternal Uncle 1: | ||
Maternal Uncle 2: | ||
Paternal Uncle 1: | ||
Maternal Cousin 1: | ||
Maternal Cousin 2: | ||
Paternal Cousin 1: | ||
Paternal Cousin 2: |
Relative | Hay Fever (age of onset) |
Asthma (age of onset) |
Emphysema (age of onset) |
Tuberculosis (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | Pre-Teens | |||
Sister 1: | Pre-Teens | |||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | Pre-Teens | |||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Lung Cancer (age of onset) |
Pneumonia (age of onset) |
Other Respiratory Disorder (age of onset & disorder) |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Sister 1: | |||
Sister 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Uncle 1: | |||
Maternal Uncle 2: | |||
Paternal Uncle 1: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: |
Relative | Ulcers (age of onset) |
Gall Stones (age of onset) |
Hepatitis A (age of onset) |
Hepatitis B (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | 30's | |||
Father | ||||
Sister 1: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
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: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Cystic Fibrosis (age of onset) |
Intestinal Cancer (age of onset) |
Other Gastro-Intestinal Disorder (age of onset & disorder) |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Sister 1: | |||
Sister 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Uncle 1: | |||
Maternal Uncle 2: | |||
Paternal Uncle 1: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: |
Relative | Diabetes (age of onset) |
Hypoglycemia (age of onset) |
Thyroid Cancer (age of onset) |
Thyroid Disease (age of onset) |
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Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Goiter (age of onset) |
Adrenal Disorder (age of onset) |
Hyperactivity (age of onset) |
Other Metabolic/Endocrine Disorder (age of onset & disorder) |
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Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
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) |
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Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Undescended Testicle(s) (age of onset) |
Hypospadiasis (age of onset) |
HPV/Genital Warts (age of onset) |
Genital Herpes (age of onset) |
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Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Prostate Cancer (age of onset) |
Uterine Fibroids (age of onset) |
Ovarian Cysts (age of onset) |
Cancer of the Cervix (age of onset) |
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Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Cancer of the Uterus (age of onset) |
Varicocele | Other Genital/Reproductive Disorder (age of onset & disorder) |
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Self | |||
Mother | |||
Father | |||
Sister 1: | |||
Sister 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Uncle 1: | |||
Maternal Uncle 2: | |||
Paternal Uncle 1: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: |
Relative | Acne (age of onset) |
Scarring Acne (age of onset) |
Eczema (age of onset) |
Psoriasis (age of onset) |
---|---|---|---|---|
Self | Teens | |||
Mother | ||||
Father | Teens | |||
Sister 1: | Teens | |||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | Teens | |||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Skin Cancer (age of onset) |
Pigmentation Disorders (age of onset) |
Other Skin Disorder (age of onset & disorder) |
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Self | |||
Mother | |||
Father | |||
Sister 1: | |||
Sister 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Uncle 1: | |||
Maternal Uncle 2: | |||
Paternal Uncle 1: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: |
Relative | Migraines (age of onset) |
Mental Retardation (age of onset) |
Alzheimers (age of onset) |
Multiple Sclerosis (age of onset) |
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Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Cerebral Palsey (age of onset) |
Epilepsy (age of onset) |
Hydrocephalus (age of onset) |
Spinal Cord Disorder (age of onset) |
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Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
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: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
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: | ||||
Sister 2: | 20's | |||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
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: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Osteoporosis (age of onset) |
Dwarfism (age of onset) |
Arthritis (age of onset) |
Gout (age of onset) |
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Self |
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Mother |
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Sister 2: |
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Maternal Grandmother |
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70's | ||
Maternal Grandfather |
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Paternal Grandmother |
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Paternal Grandfather |
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Maternal Uncle 1: |
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Maternal Uncle 2: |
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Paternal Uncle 1: |
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Maternal Cousin 1: |
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Maternal Cousin 2: |
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Paternal Cousin 1: |
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Paternal Cousin 2: |
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Relative | Myasthenia Gravis (age of onset) |
Other Muscle/Bone/Joint Disorder (age of onset & disorder) |
---|---|---|
Self | ||
Mother | ||
Father | ||
Sister 1: | ||
Sister 2: | ||
Maternal Grandmother | ||
Maternal Grandfather | ||
Paternal Grandmother | ||
Paternal Grandfather | ||
Maternal Uncle 1: | ||
Maternal Uncle 2: | ||
Paternal Uncle 1: | ||
Maternal Cousin 1: | ||
Maternal Cousin 2: | ||
Paternal Cousin 1: | ||
Paternal Cousin 2: |
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: | ||||
Sister 2: | ||||
Maternal Grandmother | 50's | |||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Color Blindness (age of onset) |
Glaucoma (age of onset) |
Deviated Septum (age of onset) |
Sinusitis (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Sister 1: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | 60's | |||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |
Relative | Other Sight/Hearing/Olfactory Disorder (age of onset & disorder) |
---|---|
Self | |
Mother | |
Father | |
Sister 1: | |
Sister 2: | |
Maternal Grandmother | |
Maternal Grandfather | |
Paternal Grandmother | 40's Deafness in left ear |
Paternal Grandfather | |
Maternal Uncle 1: | |
Maternal Uncle 2: | |
Paternal Uncle 1: | |
Maternal Cousin 1: | |
Maternal Cousin 2: | |
Paternal Cousin 1: | |
Paternal Cousin 2: |
Relative | Alcoholism (age of onset) |
Drug Abuse or Addiction (age of onset) |
Smoker/Tobacco Use (age of onset) |
---|---|---|---|
Self | |||
Mother | Teens | ||
Father | 20's | ||
Sister 1: | |||
Sister 2: | |||
Maternal Grandmother | Teens | ||
Maternal Grandfather | 20's | Teens | |
Paternal Grandmother | Teens | ||
Paternal Grandfather | |||
Maternal Uncle 1: | Teens | Teens | |
Maternal Uncle 2: | Teens | ||
Paternal Uncle 1: | 20's | ||
Maternal Cousin 1: | |||
Maternal Cousin 2: | Teens | ||
Paternal Cousin 1: | |||
Paternal Cousin 2: |
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 | 40's | |||
Father | ||||
Sister 1: | ||||
Sister 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: |