Intended Parent Questionnaire For Surrogacy
Thank you for taking the time to fill out our questionnaire so we can better serve you.
Email address *
Name *
Your answer
Partner's Name or Single Parent *
Your answer
City *
Your answer
State *
Your answer
Phone *
Your answer
Age *
Your answer
Partner's Age *
Your answer
Relationship Status *
Parentage laws vary from state to state. This information helps us propose the most friendly surrogate states specific to your needs.
Fertility Clinic *
If you have not selected a provider, we can provide you referrals. We have worked with over 150 IVF Clinics across the United States.
Your answer
Fertility Clinic City *
Your answer
Fertility Clinic State *
Your answer
Fertility Doctor *
Your answer
Surrogate's Location *
If you require your Surrogate to live in a certain region of the country, please describe where. Keep in mind that your ability to match with a Surrogate will be greatly increased if you extend the region where she is located
Your answer
Surrogate's Fee *
Please check the Surrogate Fee boxes so we know which Surrogates to introduce you to.
Required
Are you using an egg or sperm donor? *
Parentage laws vary from state to state. This information helps us propose the most friendly surrogate states specific to your needs.
Do you currently have embryos ready? *
If no to above, are you currently in an egg cycle?
How did you learn about Fertility Bridges? *
Terms of Use *
By submitting this form, you understand that the Fertility Bridges staff are not medical, legal or insurance professionals and information we give you should not be construed as advice. We serve as liaison between you and the medical, legal and insurance community and other fertility professionals to assist you in your Surrogacy journey. You agree to hold Fertility Bridges, and its staff harmless from any actions that might result from our communications and services we provide to you or on your behalf.
A copy of your responses will be emailed to the address you provided.
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