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Egg Donor ▾
Egg Donation
What Is Involved in Being a Donor?
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Egg Donor FAQs
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Intended Parents
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Surrogate
Become a Surrogate
Surrogate FAQs
Surrogacy Application
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Surrogacy Application
First name
Last name
Phone
Birthday
Address
Email
Ethnicity
Which state/country were you born?
Height
Hair color
Weight
Eye color
Blood type
BMI
Occupation
What is your current marital status?
If you are married, your husband/partner's name
What is your highest level of education?
Are you prepared to attend all of your local medical appointments?
Are you currently parenting at least one of your biological children
What is the primary source of income for your family?
When would you prefer to start your journey towards surrogacy?
Apart from your children and partner, are there any other individuals living in your home?
Would it be possible for you to travel out of state for a duration of 2-3 days, given that your travel expenses, childcare, and lost wages are covered? *
Do you have an existing health insurance policy? *
Do you consume alcoholic beverages?
Have you or your partner ever been subject to an investigation by a child protection agency?
Are you or your partner currently involved in any legal proceedings or claims?
If yes on previous question, please explain
Have you or your partner ever been involved in any lawsuit?
If yes on previous question, please explain
Have you ever consumed any prohibited substances? If yes, what did you use and when was the last time? ( please note that you will be tested)uestion, please explain
Do you encounter any second-hand smoke in your living or working environment?
Have you or your partner ever been arrested? (including DUI arrests)
If yes on previous question, please explain
Have you ever been a surrogate or egg donor before? If yes, how many times?
In what situations would you contemplate the possibility of ending a pregnancy? For instance, upon medical advice, for selective reduction, or due to severe abnormalities?
In what situations would you contemplate the possibility of ending a pregnancy? For instance, upon medical advice, for selective reduction, or due to severe abnormalities? *
During this surrogacy journey, how many babies are you comfortable with carrying? *
How many biological children do you have?
Do you have legal custody of your children ?
Are all of your children living with you ?
Are you considering expanding your own family in the future?
What is your current birth control method?
Do you take any medication regularly
Do you have a regular menstrual cycle?
If yes on previous question, please explain
Do you have any past or current medical issues?
If yes on previous question, please explain
Are you allergic to any medication?
If yes on previous question, please explain
Have you ever been prescribed any medications in the last 5 years?
If yes on previous question, please explain
Have you had any surgeries?
If yes on previous question, please explain
Have you ever been diagnosed with
Have you had any abortions?
Have you ever had any miscarriages? This excludes any chemical pregnancies (where the heartbeat was never detected)
Have you been vaccinated for covid-19?
Was your first pregnancy a personal one or part of a surrogacy journey?
Weeks of Gestation
Number of babies delivered?
The weight of your newborn
Was your second pregnancy a personal one or part of a surrogacy journey?
Weeks of Gestation (second delivery)
Date of your first delivery
Any complications? If yes, what it was?
What was the method of your baby’s delivery?
Gender of your first child(ren)
Date of your second delivery
Any complications? If yes, what it was?
Number of babies delivered?
What was the method of your baby’s delivery?
The weight of your newborn
Gender of your second child(ren)
Please provide the dates and times of any additional deliveries
Have you or your partner, if applicable ,ever had psychological counseling?
Have you ever been prescribed any psychiatric medications? (including anti-depressants and anti-anxiety medications) *
Have you ever been hospitalized for psychiatric care?
Have you ever attempted suicide?
Have you ever been diagnosed with any of the following
Why do you want to become a surrogate?
What information would you like the Intended Parents know about you?
What kind of relationship would you like with your IP's during your surrogacy journey? (friendship, very little to NO communication)
Would you be comfortable with the IP's in the delivery room
Would you be willing to pump after delivery?( you will be paid well)
Are you comfortable having the IP in the transfer room/or recording the transfer for the IP?
Are you comfortable with taking medication for surrogacy
Can you identify at least two individuals who are part of your support network? what type of relationship it is ?
Describe your personality?
What does your daily routine consist of?
What are your hobbies?
What is your favorite way to spend time with your family?
What is your favorite color?
What is your favorite flower?
What is your favorite way to relax?
What is your favorite dessert, candy or snack food?
Favorite type of jewelry? (I.E. rings, necklaces, or bracelets?)
Please upload a recent picture of you
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Please confirm that all of your answers are true and that you have no willful misunderstanding of our questions
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