Physical
Height:
5'9"
(175 cm) |
Weight:
224 lb
(101 kg) |
Eye Color:
Hazel
|
Hair:
Black/
Straight |
Skin Tone:
Light
|
Ancestry:
Caucasian
|
Blood Type:
O+
|
Ethnic Background:
Spanish/French-Scottish
|
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Education:
PMP Certification
|
Occupation:
Management
|
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Interests:
|
Building computers, Carpentry, Motorcycles, Soccer
|
Medical
Question | Response |
Have you or any of your family members been diagnosed with alcoholism or drug addiction? If yes, relation and age affected: | No |
Any dietary restrictions? If yes, explain: | No |
Do you wear glasses or contact lenses? Are you near or far-sighted? | Yes - Near-sighted, L: -0.20 R: -0.30 |
Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused: | No |
CMV IgG Antibody | Negative |
CMV IgM Antibody | Negative |
Note any comments regarding above items: | N/A |
Family Medical HistorySee list of questions asked here
Your Mother
Question | Response |
Current age or age at death | 51 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father
Question | Response |
Current age or age at death | 52 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Sisters
Your Sister 1
Question | Response |
Current age or age at death | 30 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Father
Question | Response |
Current age or age at death | 75 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Mother
Question | Response |
Current age or age at death | 65 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Car Accident |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No diagnosed health problems at time of death
Your Mother's Sisters 1
Question | Response |
Current age or age at death | 49 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 1
Question | Response |
Current age or age at death | 48 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Father
Question | Response |
Current age or age at death | 76 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Mother
Question | Response |
Current age or age at death | 78 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Sisters 1
Question | Response |
Current age or age at death | 48 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Religion:
Faith | Other |
Denomination | Agnostic |
Updates to Profile
Update Available | N/A |
Updates - Personal | N/A |
Updates - Medical | N/A |
Updates - Family Medical History | N/A |