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Your Physical Attributes

Birth Date

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Additional Information

Are you using birth control?

Do you smoke?

Do you have children?

What method of birth control do you use?

Have you been a donor before?

How many children do you have?

Occupation

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Required Questions

FDA regulations require that we ask you the following questions. Your complete honesty and accuracy are essential and appreciated. A "Yes" answer to any of the following questions will not necessarily disqualify you.

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