Become a Donor at New Hope Fertility Clinic

Dr. John Zhang is a leading fertility specialist in NYC and one of a few infertility doctors in NYC region to offer the latest and the most advanced IVF treatments.

NYC fertility clinic New Hope Fertility is among the best ivf clinics in NYC brings together a team of world-class, best fertility specialists that are committed to bring you the best of tomorrow’s IVF treatment, today. Our extensive experience with customized, minimal stimulation IVF treatments and personalized IVF protocols allows us to create successful IVF treatment options, that can only be made in the best infertility clinic in NYC.

First Name **

Last Name **

Address **

Address 2 / Apt. #

City **

State **

Zip **

Country **

Phone **

Email Address **

Confirm Email **

Date of Birth **

Weight **
lbs.

Height **
ft. in.

Hair Color **

Eye Color **

Race **

Ethnic Origin **

Are you eligible to work in the US? **
 Yes No

Occupation **

What is your highest level of education? **

If you chose "Other" please explain:

Have you applied or been screened to be an egg donor before? **
 Yes No

If so, where?

Have you successfully completed an egg retrieval procedure before? **
 Yes No

If so, where?

Are you currently enrolled as an egg donor in another program? **
 Yes No

If so, where?

Where did you hear about us? **

If you chose "Referral" or "Other", please specify:

Are you a smoker? **
 Yes No

Are your periods regular? **
 Yes No

Have you ever been pregnant? **
 Yes No

If yes, when and what was the outcome?

Have you ever had an abortion? **
 Yes No

If yes, when?

Have you ever had a sexually transmitted disease? **
 Yes No

If yes, what and when?

Have you ever used any kind of recreational drugs such as marijuana, LSD, heroin, ecstasy, or cocaine? **
 Yes No

If yes, please give details and date last used?

Are you currently taking any medications? **
 Yes No

If yes, what type?

List medications (not listed above) that you've taken in the past 5 years:

Have you ever had surgery (including cosmetic surgery)? **
 Yes No

If yes, what type and when?

Do you have any illnesses? **
 Yes No

If yes, what kind?

Do you or any of your family members have a history of cancer? **
 Yes No

If yes, who and what kind?

Do you have a history of birth defects in your family? **
 Yes No

If yes, who and what kind?

Have you acquired a tattoo or other skin piercing within the last 12 months? **
 Yes No

If yes, when?

Have you lived outside the US? **
 Yes No

If yes, when and where?

Please use the space below to provide any additional information you think may be relevant: