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Questionnaire
*
Indicates required field
Name
*
First
Last
Email
*
Section 1: These are background questions about your family
Are you married
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Yes
No
Spouse/Partners Name
*
Is anyone else over 18 years old in your home
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Yes
No
If yes please put their name(s) here
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Are you working?
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Yes
No
If you are working what type of work do you do and approximate salary
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How many children in your household
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First Name and age of children in the household
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How many times have you been pregnant
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How many live births
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Number of C-sections
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Date of birth of oldest child
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Location of birth of oldest child (eg, hospital)
*
If you have any other child please list their birth dates and locations of birth
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Does anyone in your house smoke, use drugs, drink excessivelyne
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Yes
No
If you answered yes to the previous question, please explain
*
Do you have family/friend support for your surrogacy journey
*
Yes
No
Who is your support
*
Section 2: The following questions are specifically about being a surrogate
Why do you want to be a surrogate
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When did you start thinking about being a surrogate
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Are you wiling to carry multiples
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Yes
No
Uncertain
How many embryos are you willing to transfer
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1
2
I don't know
Are you willing to work with intended parents from all ethnic backgrounds and sexual orientations
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Yes
No
If answered No to the previous question, please explain what intended parents you would like to work with
*
Are you willing to work with intended parents from other countries
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Yes
No
Are you willing to travel out of your state for appointments
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Yes
No
Uncertain
What is your expected compensation as a surrogate (If you are not certain please write - I don't know)
*
Are you flexible on your compensation level
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Yes
No
Do you have any concerns about being a surrogate
*
Section 3: The following questions are personality questions which help with the matching part of the journey
Favorite color
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Favorite animal
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How important is communication with the intended parents for you
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Would you like to maintain contact with intended parents after birth
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Is there anything you are specifically looking for in intended parent(s)
*
How would you describe your home
*
How would you describe your personality
*
Are you wiling to have your profile shown publicly on the www.afamilytreesurrogacy.com website
*
Yes
No
Uncertain
Profile will not include your full name, and it won't have your address. It will include profile picture(s) and some basic information
Congratulations! You are finished. If you haven't already could you please email at least two pictures of yourself (can include your family if you want) for your profile.
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Home
Surrogates
Compensation
Steps to Becoming a Surrogate
Application
Surrogate Mother Referral Bonus
Intended Parents
Find A Surrogate
LGBTQ+ Surrogacy
Costs and Financing
Surrogate Mother Profiles
Intended Parent Quick Application
About
Contact
Blog
Fertility Clinics
Egg / Embyro Donation
>
Egg Donor Application
News & Events
