Intended Parent Questionnaire

Before you fill out and submit this form, thereby agreeing to our Terms of Use at: https://www.dropbox.com/s/v09tlwmc1twi51v/Terms%20of%20Use%202018.pdf?dl=0

We have over 100 repeat egg donor who have donated before and a total of nearly 400 college educated egg donors. Without a password, you can preview a snapshot of the Fertility Bridges Egg Donor Database Donor Database file here:
https://www.dropbox.com/s/ga79292ywi0uw9g/Excel_ED%27s_May_2019.xlsx?dl=0

Please call Fertility Bridges' main office at 888-482-7434 or email contact@fertilitybridges.com with any questions you may have prior to submitting this form. It is our pleasure to help you in any way.

Email address *

First Name *

Last Name *

Phone *

Partners' Name or "Single Parent" *

Relationship Status *

Married

Engaged

Committed

Single

Other:

City *

State *

Country *

Age *

Partner's Age *

Fertility Clinic Name *

We have worked with over 150 Fertility Clinics across the country and can make a recommendation if you are looking at clinic options. Write N/A if you haven't selected one yet.

Fertility Clinic City *

Fertility Clinic State *

Fertility Doctor *

Egg Donor Characteristics

Characteristics you are looking for a in a Donor, such as: color of eyes or hair, height or ethnicity. If you send a photo of yourself to jessica@fertilitybridges.com, we will search through our Donors for you and send the women we think are a potential match with your physical traits and your provided criteria. We will include Donor profiles who aren't available on the website yet.

Surrogacy *

I will not need to work with a Surrogate

I will need to work with a Surrogate

I would like Fertility Bridges to contact me about their Surrogacy program

I already have a Surrogate that I am working with

Surrogate Agency I'm working with stated in other box-

Other:

Required

Anonymity

I require an anonymous egg donor.

I require knowing the Donor's identity, Known/Open Donation.

I want to send anonymous heartfelt notes and/or a gift to the Donor thanking her.

I want to let the Donor to know if I achieved a pregnancy or birth

I want to send the Donor photos of any child born from her eggs.

I want to meet the Donor at a public place organized by Fertility Bridges.

I want to speak with the Donor on the phone or by video.

Other:

Attorney

Do you have an Egg Donor Attorney? Most IVF clinics require a legal clearance letter from an attorney before they will do your egg donor cycle.

Yes

I would like a referral

Clear selection

How did you learn about Fertility Bridges? *

IVF Clinic - Your clinic gave you our contact information. We will be sure to thank them.

Google

Google Ad - You clicked one of our ads that appeared during your online search.

Yahoo!

Online Search Engine

ASRM

Friend

Trustpilot Reviews- https://www.trustpilot.com/review/fertilitybridges.com

Facbook- https://www.facebook.com/fertilitybridges/ Please visit or join our 200,000+ Fans

Twitter- https://twitter.com/Fertilitybridge

Instagram- https://www.instagram.com/fertilitybridges/

Other:

Donor Fees

What Donor fee are you able to afford? We have over 400 Donors ranging in fees from $3,500 to $10,000+. Repeat Donors with good success often have higher fees, though you may save money on screening costs. We provide Donor suggestions so they fit within your affordability range. (* We do have special programs for our lower income clients who qualify.)

$3,500-$5,000

$5,000-$6,500

$6,500-$8,000

$8,000 - $10,000

Other:

Donor Notifications

Would you like to know of potential Donors, who fit your characteristics, just prior to being entered into our Database? This may give you the opportunity to match with a Donor before others see her profile online. Donors with favorable characteristics often match the first day and develop a waiting list quickly. Donor alert emails will be sent to the email you listed above, unless you write another email in the "other" section below.

Yes

Other:

Clear selection

Client Contact *

Please check both boxes below.

I understand that I will receive emails and phone calls from Fertility Bridges with Donor suggestions and information about how to access and use the Donor Database.

I understand that access to our Donor Database is confidential and only permitted to those Intended Parents who are serious about working with an Egg Donor.

Required

By submitting this form, you agree to the Fertility Bridges Terms of Use for using our online Egg Donor Database located at: https://www.dropbox.com/s/v09tlwmc1twi51v/Terms%20of%20Use%202018.pdf?dl=0

I agree to the Fertility Bridges Terms of Use for logging in and using the Fertility Bridges Egg Donor Database which is similar to an anonymous private social network.

I understand that Fertility Bridges Terms of Use are subject to change and I should periodically check in for updates if I continue to use the Egg Donor Database.

I agree to stop logging in and using the online database if I do not agree with the Terms of Use.

Required

Directions for Using the Online Database *

I agree to carefully follow the directions for logging in to the Egg Donor Database provided in my welcome email and at this link: https://www.dropbox.com/s/v09tlwmc1twi51v/Terms%20of%20Use%202018.pdf?dl=0

Yes, I agree to follow the directions carefully.

I understand that I will never use my own email to login to the database and instead will be assigned an email that I will never change or delete since it is a general access account shared by all anonymous Intended Parents.

Required

Database Interactive Anonymity *

You are welcome to ask Donors questions as long as you anonymously identify yourself, such as "IP from Chicago".

I understand that the Fertility Bridges Online Database (www.fertilitybridgesnetwork.com) provides a feature that allows me to anonymously communicate with the Egg Donors in the Program. Fertilitybridgesnetwork.com is similar to a private social network with only anonymous Egg Donor profiles (without their contact information or real names) and ONLY ONE SHARED anonymous Intended Parent account to view those anonymous Donors.

I understand I should never use my contact information and only operate anonymously, once I login in to the Egg Donor Database social network at www.fertilitybridgesnetwork.com.

I understand that any interaction I have anonymously with Donors at www.fertilitybridgesnetwork.com is monitored by the Fertility Bridges Staff in order to help facilitate my match.

I understand that I should never use my full real name, email, phone number, address, or any other contact information in any communication with a potential Egg Donor in this special private social network and if I do it will be seen by all Intended Parents sharing my account and accessing the database at that time.

I understand I should never elicit private contact information from a donor. Fertility Bridges will safely mediate all communitcation until a time when legal contracts are provided for a open/known donation agreed to by all parties.

Required

Dono Availability *

It is best to start your egg donation search with at least 10 Egg Donor candidates in mind. Due to the busy schedules of many Donors, especially repeat Egg Donors, you may not be able to secure your first choice of Donor for the schedule you want. If timing is very important to you, and you don't want to wait 6 months for your 1st choice Donor to become available, then we recommend that you expand your horizons and think about matching with other lovely amazing Donors who are available.

I understand some Donors may not be available for 6 months or longer to do my egg donation cycle.

I understand that it is impossible for Fertility Bridges to keep over 400 donor profiles up to date because donors may change their schedules or location. Information, such as availability and fees, should always be double checked for accuracy with a Fertility Bridges Coordinator before considering the donor.

Required

Agency Fees *

Fertility Bridges is a third party fertility consulting agency that can help you find an Egg Donor and coordinate your Egg Donor cycle with your fertility clinic. After you have selected an available Donor in our database and she completes her agency agreement for your match, we will then request a $3,000 cooridnation fee from you. An additional fee is due once your selected Donor is medically screened and cleared by your fertility clinic to proceed. The initial $3,000 fee covers our consulting time with you during your match selection process and one Egg Donor cycle coordination with a Donor in our program or in another program.

I understand my initial $3,000 fee to Fertility Bridges is applicable to any one donor cycle and one replacement donor cycle (if needed) and is non-refundable.

I understand that the second fee will be due after my selected Fertility Bridges Donor is cleared by my IVF clinic to begin an Egg Donor cycle with me. The additional fee is $4,500. This fee is refundable if a cycle does not begin. Payment plans are available.

I understand that the second fee is only refundable if my Donor is unable to begin her donor cycle medications in a reasonable amount of time.

I understand that no one can legally enforce a Donor to donate her eggs.

I understand that Fertility Bridges can help me find a replacement Donor, within Fertility Bridges or at other Donor Agencies, if my first choice Fertility Bridges Donor does not complete my egg donor cycle for any reason. Fertility Bridges will coordinate my next replacement egg donor cycle at no cost, though I will be responsible for any replacement or changes in Donor fees.

I understand that any Donor expenses and Donor fees are additional and separate from any monies paid to Fertility Bridges for their services.

Required

Submit

Never submit passwords through Google Forms.

This form was created inside of Fertility Bridges. Report Abuse

Forms