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Dear Potential Grace Donor

We would like you to consider the following before proceeding with the Grace application form:

  1. 1. A Grace Donor, if/when chosen to donate will be required to attend 7 clinic appointments, will you be able to commit to the time as they happen during working hours – not after hours or on weekends.
  2. 2. Do you have the full support of your family? Husband, Boyfriend, Partner, Parents, etc?
  3. 3. Have you read the Grace Donor FAQ's? If not, please visit this link as they are extremely helpful

-- Only ages between 19 and 33 permitted
Weight in kilograms:
Height in meters:

Below is a list of medical conditions pertaining to you and/or your immediate family members,
please read them carefully and respond with a Yes or a No.

Do you have/have you had any allergic reactions to anaesthesia?
Do you have asthma?
Bi-Polar/Schizophrenia in you or any of your immediate family members?
Do you have/have you had breast cancer or breast cancer in two or more immediate family members?
Are you breast feeding or pregnant?
Do you have depression where one or more anti-depressants are being taken?
Diabetes – Type 1 in (yourself or immediate family)
Do you have epilepsy?
Glaucoma: Yourself or immediate family (parents or Grandparents)
Haemophilia/bleeding disorder: Yourself or immediate family
Are you HIV Positive?
Are you a Virgin?