Physical
Height:
5'8"
(172 cm) |
Weight:
160 lb
(72 kg) |
Eye Color:
Brown
|
Hair:
Brown/
Wavy |
Skin Tone:
Medium Light
|
Ancestry:
Multi
|
Blood Type:
O+
|
Ethnic Background:
French-Mexican/Irish-Scandinavian
|
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Education:
AA/Communication
|
Occupation:
Student
|
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Interests:
|
Cycling, Music, Singing, Working out, Writing
|
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? | No |
Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused: | No |
CMV IgG Antibody | Positive |
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 | 43 |
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 | 59 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Diabetes
51
Diet and lifestyle changes
Brothers
Your Brother 1
Question | Response |
Current age or age at death | 16 |
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 | 22 |
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 | 85 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Heart failure |
Health Problems
Healthy
Your Mother's Mother
Question | Response |
Current age or age at death | 78 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Heart failure |
Health Problems
Healthy
Your Mother's Sisters 1
Question | Response |
Current age or age at death | 50 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Sisters 2
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 Mother's Sisters 3
Question | Response |
Current age or age at death | 41 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Sisters 4
Question | Response |
Current age or age at death | 15 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Trauma |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Trauma from car accident
15
None
Your Mother's Brothers 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 Father's Father
Question | Response |
Current age or age at death | 70 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Natural causes |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Died in his sleep, in his 70s
N/A
Your Father's Mother
Question | Response |
Current age or age at death | 74 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Heart failure |
Health Problems
Healthy
Your Father's Sisters 1
Question | Response |
Current age or age at death | 67 - Maternal half sister |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Sisters 2
Question | Response |
Current age or age at death | 63 - Maternal half sister |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Sisters 3
Question | Response |
Current age or age at death | 62 - Maternal half sister |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Sisters 4
Question | Response |
Current age or age at death | 57 - Maternal half sister |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Diabetes requiring insulin therapy
47
N/A
Your Father's Brothers 1
Question | Response |
Current age or age at death | 70 - Maternal half brother |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Brain aneurysm |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Brain aneurysm
70
None
Your Father's Brothers 2
Question | Response |
Current age or age at death | 69 - Maternal half brother |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Brothers 3
Question | Response |
Current age or age at death | 65 - Maternal half brother |
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 |