Surrogate Profile

Self introduction

Gestational Carrier Full Profile

Section I. Personal Information

Profile ID

E-mail Address

Password

Age

Height

BMI

Ethnicity

Occupation

Education

Skin Color

Hair Type

Religion at Birth

Still Practicing？

How many people live with you currently and what relationship?

Profile Photo

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Face photo

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Full length body photo

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How many times you have been a surrogate before？

Sexual Orientation

State

DOB

Weigh

Blood Type

Race

Marital Status

Partner Occupation

Do you plan to further your education？

Base Compensation

Natural Hair Color

Natural Eye Color

What languages do you or your family speak?

Family photo

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Recreational photo

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Other photo

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Section II. Birth Records

Number of Pregnancies

Number of Abortions

Number of Deliveries

Number of Child(ren) Currently Raising

Number of Miscarriages

Baby 1

Delivery Date

Gender

Weight

Gestational Age

Vaginal or C-Section Delivery?

Baby 2

Delivery Date

Gender

Weight

Gestational Age

Vaginal or C-Section Delivery?

Baby 3

Delivery Date

Gender

Weight

Gestational AgeGestational Age

Vaginal or C-Section Delivery?

Baby 4

Delivery Date

Gender

Weight

Gestational Age

Vaginal or C-Section Delivery?

If you had miscarriage/abortion, please specify the EXACT date, GESTATIONAL AGE and METHOD (natural, pills, surgery, etc.) for EVERY miscarriage/abortion below. Please provide other details as much as possible.

If you are currently using contraceptive method, please specify the TYPE (IUD, nuvaring, pill, patch etc.) and if it is HORMONAL below. If you currently have an IUD implant, please also provide when you schedule to remove it and how long your hormone level will be normal for pregnancy after the removal.

If you have any complication during pregnancy and labor, please specify it below as detailed as possible, including ALLmedication, injections or procedures taken because of your complications. Common complications include preterm labor/premature delivery (before 37 weeks for singleton and 34 weeks for twins), hypertension, gestational diabetes, preeclampsia and severe anemia etc.

Section IV. About Surrogacy

Be advised that we will try to match you with ideal IPs based on your answers in this section, so please answer after thorough considerations. You are subject to change your answers later, but it WILL result in a longer matching process.

What is the maximum number of embryos you are willing to have transferred to you at each appointment?

What is the maximum number of babies you are willing to carry for the journey?

If a multiple pregnancy is confirmed, would you undergo a selective reduction procedure based on the advice of the physicians?

If there is a medical problem with the pregnancy, or with the child you are carrying as a surrogate and the Intended Parents want to consider abortion, would you allow them to make that decision based on the advice of their physicians and personal beliefs?

Do you agree to undergo an amniocentesis if the physician or the Intended Parents request one?

Would you be willing to pump, freeze, and ship your breast milk if your IPs requested it for their child?

At the birth of the baby, are you comfortable with your IPs being in the delivery room?

Would you agree to sign necessary legal documents to assure the intended parents that you will relinquish all your parental rights to their child?

Do you and your partner understand that, unless you have had a tubal ligation, or your partner has had a vasectomy, you must agree to abstain from sexual activity while undergoing medical treatment and participating in this program?

Please see all types of Intended Parents and list all types you would like to be matched with.

Heterosexual Couples
Single Individual
Couples Using a Sperm Donor

Elder Couples
Interracial Couples
International Couples Living Outside US

Couples Using an Egg Donor
Homosexual Couples
Couples Who Are Not Native Speakers of English

Please list all types of Intended Parents you would like to be matched with here: Heterosexual Couples, Homosexual Couples, Single Individual, Interracial Couples, Couples Using a Sperm Donor, Couples Using an Egg Donor, International Couples Living Outside US, Couples Who Are Not Native Speakers of English, Elder Couples, All Above.

If you have special requirements (such as religion, belief etc.) regarding the IPs you would like to be matched with, please specify it below. Also, please list any circumstances in which you would NOT consider working with IPs.

Please answer the following questions in detail:

Would you like to meet the intended parents?

What is your primary support group during your journey?

Why do you want to be a surrogate?

What do you plan to tell your children about you being a Surrogate？

What relationship do you want with the Intended Parents during conception and pregnancy？

What kind of relationship do you want to have with Intended Parents after the birth, if any?

What qualities would you consider most important in choosing Intended Parents?

How would you respond if the child wanted to see you at some time later in the future?

What message would you like to pass on to the intended parents?

Only fill in if you are not human

Surrogate Profile

Gestational Carrier Full Profile

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