Poma Fertility - Donor Questionnaire

Questionnaire

Poma Fertility
Have a question?
(425) 822-7662

Become an Egg Donor with Poma Fertility

Required fields cannot be empty

Become an Egg Donor! Earn $7,000 - $10,000

1

2

3

Donor FAQs

Have questions before applying?

Read our FAQ

Apply Now

Estimated completion time:
3-5 minutes

Help Families. Reach Your Goals.

Earn $8,000–$10,000 & change lives!

We’re looking for donors who:

Are 21–32 years old
Have a BMI between 18–30
Have at least a high school diploma or GED
Don’t use nicotine or recreational drugs
Can make weekday morning appointments (7–9 AM)
Live within 50 miles of Kirkland

Already started an application? Sign In

1. What is your first name? *

2. What is your last name? *

3. What is your zip code? *

4. In which country were you born? *

United States
Canada
Mexico
Other

Please Explain

5. Are you a US citizen or permanent resident? *

Yes
No

Please Explain

6. Are you eligible to work in the United States? *

Yes
No

Please Explain

7. What is your cell phone number? *

8. Do you give us permission to text you? *

Yes
No

9. What is your height? *

10. What is your weight (lbs)? *

11. What is your date of birth? *

12. Are you adopted? *

Please Explain

13. Which ethnicity do you identify with? *

Please go into more detail about your ethnicity. If you're Native American or Alaska Native, are you a member of a tribe?

14. Do you have a drivers license or state issued ID? *

Yes
No

Please Explain

an Error Occurred

1

2

3

Donor FAQs

Have questions before applying?

Read our FAQ

Apply Now

Estimated completion time:
3-5 minutes

Help Families. Reach Your Goals.

Earn $8,000–$10,000 & change lives!

We’re looking for donors who:

Are 21–32 years old
Have a BMI between 18–30
Have at least a high school diploma or GED
Don’t use nicotine or recreational drugs
Can make weekday morning appointments (7–9 AM)
Live within 50 miles of Kirkland

Already started an application? Sign In

1. What is your current occupation? *

2. What is your highest level of education?
If you're in college now, please select "Currently Enrolled in College". *

What was your degree in and/or what was your major?

3. Do you have both ovaries? *

Yes
No

4. Have you taken Depo Provera in the last 6 months? *

Yes
No

5. Have you had a baby in the last 6 months? *

Yes
No

When did you deliver?

6. Do you have Implanon/ Nexplanon implants? *

Yes
No

7. Have you applied or been screened to be an egg donor before? *

Yes
No

Where did you apply? Did you have any testing or complete a donation?

7a. How many times have you donated? *

8. Do you smoke cigarettes and/or vape nicotine? *

How many cigarettes (or vaping) do you / did you smoke per day?

9. Have you ever used recreational or illicit drugs (cocaine, LSD, heroin, barbiturates, narcotics, opiates, amphetamines, hallucinogens, tranquilizers, PCP, steroids) for non-medical reasons? *

Yes
No

Which one(s) and when did you last use them?

10. Have you spent 5 or more years cumulative in Europe? *

Yes
No

Please Explain

11. Have you been vaccinated for COVID-19?

Yes
No

If you were vaccinated, which vaccine did you receive? And what were the date(s) of your vaccination? If you are not vaccinated, would you consider getting vaccinated?

12. How did you hear about us? *

Please explain. If you were referred to us by someone, please provide their full name.

an Error Occurred

1

2

3

Create Your Account

Email Address

Password

8 characters minimum

One special character (e.g. * or !)

© 2025 Egg Donor Connect, LLC. Terms of Use Privacy Policy Consumer Health Data Privacy Policy