Become a Sperm Donor at Public Fertility Care Sperm Bank

Questionnaire

Public Fertility Care Sperm Bank
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(03) 8345 3241

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Estimated completion time:
3-5 minutes

Thank you for your interest in becoming an sperm donor. Next steps are:

1) The Pre-screen Questionnaire: please complete the below pre-screen questions

2) Full Questionnaire: The full questionnaire will be emailed to you if your pre-screen questionnaire is successful

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1. I am interested in donating my sperm and I am aged between 23-45 years.
*

Please Explain

2. Are you an Australian Citizen or Permanent resident? *

What is your citizen status?

3. Do you live in Victoria? *

Where do you currently reside?

4. First Name *

5. Last Name *

6. Date of Birth *

7. What is your Height (in cm)? *

8. Phone number *

9. Do you consent to receiving relevant text messages from our team? *

10. Are you currently undertaking fertility treatment? *

Please provide additional details.

11. Have you donated sperm before? *

What is the name of the program you donated with and when was the date of your last donation?

12. Do you have any children? *

Please Explain

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