| Fairfax Cryobank |
| Sample Donor Summary Profile |
| Questions |
| Physical |
| Medical |
| Family History |
| Physical | |
| Race | Cauc |
| Ethnic Background | Scottish-English/German-Russian |
| Height | 6 ' 2 " |
| Weight | 205 |
| Eye Color | Green |
| Hair | Blond/Wavy |
| Skin Tone | Med |
| Blood Type | A+ |
| Education | BA/Anthropology |
| Occupation | Tech. Producer |
| Interests | Kayaking/Scuba Diving |
| Medical | ||
| QUESTION | RESPONSE | COMMENTS |
| Diet Restrictions | No | |
| Glasses | Yes | |
| Allergies | No | |
| Hearing Restrictions | No | |
| Dental Problem | No | |
| Family History | ||||
| FAMILY MEMBER | AGE/AGE OF DEATH | HEALTH PROBLEMS | AGE DIAGNOSED | LIVING/DEAD |
| Mother | 59 | receding gums | L | |
| Father | 55 | Healthy | L | |
| Sister(s) | 33 | Healthy | L | |
| Mother's Father | 66 | Stroke | D | |
| Mother's Mother | 68 | Heart failure | D | |
| Mother's Brother(s) | 57 | Healthy | L | |
| Father's Father | 40 | car accident (both killed, in their 40's) | D | |
| Father's Mother | 40 | car accident (both killed, in their 40's) | D | |
| Father's Brother(s) | 56 | Healthy | L | |