Questionnaire
Aphrodite Egg Bank
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First Name
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Last Name
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Street
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City
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State or Province
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Zip / Postal Code
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Country
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Cell Phone Number
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Is it okay to communicate with you by text message?
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When we add new donor to our platform, how often would you like to receive an email?
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Whenever a donor is posted who matches any of my selected criteria
Whenever a new donor is posted
Once a week, with a summary of all new donors posted
I'd prefer not to receive new donor email messages
Do you have a partner?
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Partner's First Name
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Partner's Last Name
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Partner's Email Address
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Partner's Cell Phone Number
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Which country do you plan to have your treatment in?
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--Select--
ARGENTINA
AUSTRIA
BRAZIL
CANADA
CHILE
COLOMBIA
CYPRUS
DOMINICAN REPUBLIC
GREECE
GUATEMALA
IRELAND
ISRAEL
KENYA
MEXICO
PARAGUAY
POLAND
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SWITZERLAND
UK
URUGUAY
USA
OTHER
If Other, please type your treament country below:
What clinic are you working with?
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Your Message for Aphrodite Egg Bank
How did you hear about us?
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