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Questionnaire for future parents
The questionnaire contains private questions, required for quality analysis of your situation. Using this data our staff will be able to choose the necessary approach, which will help you avoid different problems while the program itself and the further exporting of a baby. We guarantee privacy. All the information will be used for program realization only.
Indicate your full name please *
How can we turn to you?
Your answer
Contact informaiton *
Please, indicate your phone number, email, Skype, etc.
Your answer
Wife's date of birth
Your answer
Husband's date of birth
Your answer
Сitizenship of a wife
Your answer
Сitizenship of a husband
Your answer
The country where the couple lives *
Your answer
Are you officially married? *
Your couple consists of *
Wife's blood type
Husband's blood type
Select, please, if any of you has the following diseases *
Required
Please, indicate the languages you can speak. We need it for a correct selection of the interpreter and a surrogate mother *
Your answer
Were you pregnant in the past? How did your pregnancy end? *
Your answer
Medical recommendations for surrogacy program *
Why have you decided to use this program?
Your answer
Do you expect to use your own ovum? *
Required
Please, indicate the country where you plan to be fertilized *
Your answer
Please, indicate the country where you prefer to deliver *
Your answer
Your comments
If you have any additional information, which may affect the program, you can specify it here. We will certainly take into consideration this data.
Your answer
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