Surrogate Questionnaire

Become a Surrogate with Private Label Surrogacy

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Become a Surrogate
with Private Label Surrogacy

Estimated completion time:
3-5 minutes

Thank you for your interest in becoming a surrogate! The application process consists of two phases:

1) The Prescreen Questionnaire (complete below): This is a short questionnaire that screens you on basic surrogacy qualifications. Once you pass this stage of the application process, you will be prompted to complete the full questionnaire.

2) Full Questionnaire: Once you submit this short prescreen questionnaire and it is accepted, you will be prompted to complete the full-length questionnaire. The full questionnaire is a slightly more involved survey that dives into more detail on everyone's favorite topic - YOU! So to get started, sit back, relax and complete the pre-screen below.

Please notePrivate Label Surrogacy will decline any surrogate who is receiving government assistance of any kind. We will also decline a potential applicant if she has a spouse/partner or child she is living with receiving government assistance such as food stamps, WIC, government housing or any government insurance even if the state of residence requires this. In order for a surrogate to pass the psychological screening and attorney review she cannot be assisted by the government. Any compensation received for the surrogacy will also eliminate her from receiving benefits. The government will not pay for the prenatal visits or delivery charges for a surrogate pregnancy. 

These are guidelines that have been set by governing boards for assisted reproductive technology and we adhere to these per recommendation.

Already started an application?
Click Here to Login







1

2

3


Become a Surrogate
with Private Label Surrogacy

Estimated completion time:
3-5 minutes

Thank you for your interest in becoming a surrogate! The application process consists of two phases:

1) The Prescreen Questionnaire (complete below): This is a short questionnaire that screens you on basic surrogacy qualifications. Once you pass this stage of the application process, you will be prompted to complete the full questionnaire.

2) Full Questionnaire: Once you submit this short prescreen questionnaire and it is accepted, you will be prompted to complete the full-length questionnaire. The full questionnaire is a slightly more involved survey that dives into more detail on everyone's favorite topic - YOU! So to get started, sit back, relax and complete the pre-screen below.

Please notePrivate Label Surrogacy will decline any surrogate who is receiving government assistance of any kind. We will also decline a potential applicant if she has a spouse/partner or child she is living with receiving government assistance such as food stamps, WIC, government housing or any government insurance even if the state of residence requires this. In order for a surrogate to pass the psychological screening and attorney review she cannot be assisted by the government. Any compensation received for the surrogacy will also eliminate her from receiving benefits. The government will not pay for the prenatal visits or delivery charges for a surrogate pregnancy. 

These are guidelines that have been set by governing boards for assisted reproductive technology and we adhere to these per recommendation.

Already started an application?
Click Here to Login


None (Sexually Active)
None (Not Sexually Active)
Birth Control Pills
Condoms
Depo-Provera
IUD
Implanon
Nexplanon
Nuvaring
Patch
Spermacide
Tubal Ligation
Vasectomy
Other





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