Surrogate Pre-screening Form

Please read the information below prior to submitting the following application. This information is intended to inform about the requirements as well as the general process with our program. Once you are sure you are committed to becoming a surrogate, scroll to the bottom of the page to complete the Surrogate pre-screening form.

Surrogacy Qualifications

Most surrogacy agencies and fertility clinics require surrogates to meet the following general qualifications:

a. Be in good physical and mental health;
b. Have carried and delivered at least one child;
c. Have had pregnancies that were all free of complications and were full-term;
d. Be less than 43 years of age (some clinics will accept older woman in certain circumstances; others have younger age cut-offs for all surrogates);
e. Be in a stable living situation; and
f. Not smoke or abuse alcohol.

The timeline of a surrogacy is the following:

1. Application process

2. Medical Records Review

3. Intended parent selection (this is done by both parties to ensure the best possible match)

4. Psychological evaluation and home visit by therapist (photos are taken to provide Intended Parent with a visualization of where their baby is gestating and feel more connected to the process).

5. Medical screening is completed at the clinic (generally one close to you in driving distance). If the Intended Parents are working with a clinic elsewhere, you will be flown to the clinic without expense to you.

6. Legal agreements are completed with the Intended Parents. You will have your own attorney to represent you in the agreement and are able to make requests and adjustments to make sure you are comfortable.

7. Endometrial lining preparation occurs with the clinic of the Intended Parents. If the clinic isn’t local to you, we will have a local clinic (within a few miles from you) complete the ultrasounds and blood draws.

8. Once endometrial lining is ideal, you will go to the Intended Parents clinic for the embryo transfer.

9. 12 days later a pregnancy test occurs.

10. If positive, payments of your surrogacy fee will commence on the 1st of the month following a heart beat confirmation ultrasound.

11. At 6 months of pregnancy, there will be a Pre-birth Order issued by the court meaning the baby will be born with the Intended Parents on the birth certificate to ensure you are not legally responsible for the child.

12. For compensation, you will receive your requested surrogacy fee in 10 equal payments over the course of the pregnancy. You will also receive an additional $200 per month once the legal agreements are signed (before the embryo transfer) and until the month after delivery. If health insurance is needed (you don’t already have it), the Intended Parents will pay the premiums and then continue for three months after birth. At the time of embryo transfer, you will receive $1,000 with is earned regardless of pregnancy outcome. When you travel, you will receive mileage reimbursement of .58 per mile over 50 miles of driving. Meals, airfare, rental car, and hotel is all covered in case of flights needed (San Diego travel).

13. Throughout the process, I will be your contact and in charge of all payments for medical items, reimbursement to you, insurance, surrogacy payments, etc.

If you would like to speak with any of our prior surrogates about their experience, I would be happy to set it up for you.

Thank you for considering this! Here is the initial application should you decide you would like to apply.

First Name (*)

Middle Name

Last Name (*)

Address (*)

City Name (*)

State (*)

Zip Code (*)

Phone (*)

Email (*)

Birth Date (*)
/ /

Height (*)
feet inches

Weight (lbs) (*)

Blood Type (*)

Ethnic background (*)

Marital Status (*)

Smoker (*)

Have Health Insurance (*)
 Yes No

Insurance Company

Have you ever been a surrogate before?
 Yes No

How did you hear about us?

If referred by a friend, please give the name of friend so that we can thank them! (*)

Upload profile picture (*) - less than 3MB

Comments/questions

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