CD4034

Any past or current medical problems (including surgeries, accidents, birth defects, depression, etc.)?

Do you wear or have you worn eyeglasses? If yes, at what age did you start wearing them?

Do you drink alcohol? If yes, how many drinks per week?

Are you taking any recreational drugs? If yes, what are you taking?

Have you ever been pregnant? If yes, how many times and what was the outcome?

Are you currently taking any medication (for physical or mental health)? If yes, what medications are you on and why?

Have you ever been a donor before? If yes, did a pregnancy occur?

Do you smoke?

Have you worn braces?

Are your menstrual cycles regular? If no, please explain.