Become a Surrogate

Qualifications - Step 1 of 6

Surrogate’s Personality, lifestyle, etc

What is your ethnic background? *

Who is your current employer? *

Please list the following details for your current job: date employment started, job duties, typical work schedule *

What is your current health insurance policy? Please include name of policy (e.g. Anthem), and source of insurance (e.g. employer) *

What is your primary spoken language? *

What is your religion? *

What levels of education have you completed? *

Have you ever been arrested?（If yes, please explain） *

Have you ever been involved in a Lawsuit, Civil Case, CPS case or Bankruptcy?（If yes, please explain） *

Questions about Your Relationship Status/Partner:

What is your current relationship status? *

How long has this been your current relationship status? *

What is your Partner/Spouse's full name? (First, Middle, Last) *

What is your Partner’s/Spouse’s citizenship status？ *

What is your partner's current occupation? *

What is your Partner/Spouse's best contact number? *

Has your Partner/Spouse ever been arrested? (If yes, please explain) *

Has your Spouse/Partner ever been involved in a Law Suit, Civil Case, or Bankruptcy? (If yes, please explain) *

Do you feel you can dedicate your time and commit yourself to the surrogacy process, given your current schedule and responsibilities? *

What are your hobbies/interests? *

Use three words that best describe your personality: *

Surrogacy Journey Preference

Why do you want to be a Surrogate? *

Are you able to take time off for surrogacy related appointments, be punctual, and stay in regular communication with the agency, prospective parents, and other professionals involved in the surrogacy process? *

Do you have any blackout dates when you’d be unavailable? (Vacation/Holidays) If yes, please provide the specific date or time period *

In terms of Intended Parents, you’re willing to work with, please check all that apply: *

Who will be your support system at home and what kind of support will they provide to you during the surrogacy? *

How do you see your ideal surrogacy journey? *

What kind of relationship would you like with your intended parents during the journey and after the journey? *

What message would you like to pass on to the prospective parents? *

What reassurance can you give the IPs that you will not change your mind about relinquishing the child? *

Qualifications

Medical History

Pregnancy History

Surrogate’s Personality, lifestyle, etc

Questions about Your Relationship Status/Partner:

Surrogacy Journey Preference

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