State of Residence: California
Marital Status: Single
Do you have any children? If yes, how many? Yes, I have 3 children, girls.
 
Are you currently employed? If yes, what is your occupation? I work at a women's recovery center. I work as a peer support specialist.
 
Which words describe your personality? People would say I am fun, funny, loving, hard-working, ambitious, creative, outgoing, smart, and a good mom.

How would you describe your social life? I would say my social life is fair.

Describe yourself as a child and as a teenager: I would say as a child I had a lot of energy and was super affectionate.

Describe your strong and weak sides: I have no weak side. I would say I am tough at handling problems and dealing with whatever life throws at me.
What are your long-term goals and aspirations? My long-term goal would be to buy a house. Also, get married someday.
What is your most memorable moment? My most memorable moments were finishing high school and bringing my kids into the world. It was such a significant part of my life. Also when I completed college and earned several certifications, including my CNA certificate, CPR, CHHA, and First Aid.
How would you describe your overall mental health? 
My mental health is great I have a lot of support.
Have you ever seen a therapist or counselor? If yes, please provide details. I have not seen a consul or therapist. 
How do you manage stress? I talk to friends or family or I would speak with a consular if I feel I can’t resolve the stress. I also do self-care.
Do you have a strong support system (e.g., friends, family)? Yes I have friends and family who support me.
 
Medical history:
 
Do you have any known medical conditions or chronic illnesses? If yes, please provide details. No
Are you currently taking any medications? If yes, please list them. I am not taking any medication.
Do you use recreational drugs? If yes, please specify. I do not use drugs and never have. Never
How often do you smoke cigarettes or vape? Never
How many alcoholic drinks do you consume on a weekly basis? None
Have you ever had any surgeries? If yes, please provide details. Yes, I had breast augmentation in 2021.
Do you have any allergies (inc. food)? If yes, please specify. I have no allergies.
Have you ever been hospitalized? If yes, please provide details. I have not been hospitalized.
Do you have regular menstrual cycles? If No, please provide details. I get regular periods, every 28 days a month.

Have you ever used contraception? If yes, please s p e c i f y. I am not on contraception. I used a birth control shot in early 2024.

Have you ever had a sexually transmitted infection (STI)? If yes, please provide details. No. 
Have you ever had any fertility treatments? If yes, please provide details. No. 
Have you ever been pregnant? If yes, please provide details: number of deliveries, miscarriages, or abortions, and details of the complications (if applicable): I have 3 babies, no complications.
Have you ever donated eggs before? If yes, please provide details. I have not donated eggs.
Do you feel any pain or cramps during your period?
I do not feel no pain doing my period.
Do you have any bleeding between your periods? No
Have you ever experienced any reproductive health issues (e.g., PCOS, endometriosis)? No
Is there any case of twins or other multiple births in your family? If yes, please specify it: No
What is your sexual orientation? I am straight.
Is your relationship monogamous? Yes, I am single
What method of contraception do you currently use? None, I am single
Are you currently sexually active? I am not sexually active I am single.
When was your last Pap Smear and what was the result? My last pap was march 2024 it was negative.
Have you ever had an abnormal PAP smear? If yes, please provide the date and result, as well as if there was any sort of treatment): I have not had abnormal pap.
Have you ever taken an AMH (Anti-Müllerian Hormone) test? If so, when did you take it and what was your hormone level? No
Do you have any vision impairments, or wear glasses or contact lenses? No
Do you have any hearing impairments? no
Do you have any physical disabilities? No
Have you ever had braces on your teeth? No 
How often do you visit a doctor for regular check-ups? I go to the doctor every 6 months for check up.
Do you follow a specific diet (e.g., vegetarian, vegan)?  I cook healthy meals and prepare healthy meals. I work out 3 times a week at the gym.
Do you take any dietary supplements or vitamins? If yes, please specify.  I take vitamin C. 
 
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