Health Survey

THANK YOU for your consideration in applying to become a healthy donor and help sick patients in need with your gut probiotic bacteria.

In order to become a qualified donor, we request:
1. You are able to make regular visits to our laboratory in Central area for stool donation drop-off
2. You are exceptionally healthy
3. You successfully pass two layers of diagnostic health screening conducted by the Asia Microbiota Bank 
 
Since people with severe illness may receive the processed and recycled stool material you donate, we rely on your honesty when communicating with us. By taking this survey you consent to the Asia Microbiota Bank using your survey data to proceed with a donor application. Any data collected will be kept confidential and used only for the purpose of this donor recruitment project.

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* 1. Please enter your contact information

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* 2. Are you male or female?

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* 3. What is your age?

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* 4. Do you currently live or work near Hong Kong Central or can commute to the Central area within 1 hour?

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* 5. Can you make regular donations at least 3 times a week to our Central office location (near the Central MTR)

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* 6. Why are you interested in being a stool donor?

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* 7. How did you hear about Asia Microbiota Bank's stool donation program?

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* 8. Which community / association do you belong to? (e.g. HKMA, hiking groups, trail runner groups, Lions Club etc.)

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