Surrogate Application

Welcome to Surrogate Steps where we will guide you through each step of the process. Thank you for taking the first step in making a family’s dream come true.

Please fill out the information below to begin your journey.

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Step 1 of 5

Name*

First Last

Email*

Phone Number*

Location*

City State

Age*

How many children have you had?*

Height (Feet)*

Enter Height Above in Feet

Height (Inches)*

Enter Height Above in Inches

Weight*

(Enter pounds)

BMI

Is it okay to leave a message?*

Yes

Thank you for your interest in Surrogate Steps! We appreciate your support, but unfortunately due to state laws and regulations, we cannot accept applicants from your state at this time.

Thank you for your interest in Surrogate Steps! We appreciate your support, but unfortunately, one of the prerequisites clinics have set for becoming a surrogate is that the applicant must be between the ages of 21 and 43, must have a BMI under 34, and must have given birth to a healthy baby with no complications. Therefore, considering your answers to this application, we will not be following up with you at this time.

Disclaimer

Does anyone in your home, including yourself, smoke or take drugs?*

Yes

Are you exposed to any chemicals on a regular basis that might be harmful to a fetus?*

Yes

Disclaimer: Please note that if you have ever been medically diagnosed with endometriosis, pre-eclampsia, post-partum depression or an eating disorder, or if you are currently on any medication for depression/anxiety, you are unable to become a surrogate.

Do any of these conditions apply to you?*

Yes

Thank you for your interest in Surrogate Steps! We appreciate your support, but unfortunately, your responses do not match with our basic health criteria and we will not be following up with you at this time.

Surrogate Application

Surrogate Application

Please fill out the information below to begin your journey.

Disclaimer

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