Surrogate Preliminary Application | Fertility Alternatives Surrogacy Program

Surrogacy Preliminary Application
(This application is for Gestational Carrier candidates)

Please complete the form below.

If you meet the initial criteria an email will be send with a full application with instructions. To prevent your full application from going to spam, please add Dawn@FertilityAlternatives.com to your email Contacts and Safe-list.

First/Last Name, Email, State of residence.

Height/Weight

Number of births, miscarriages, terminations. (Please identify each that apply)

Pregnancy Complications? (Gestational diabetes, pre-term labor, pre-term birth, etc. (Please elaborate)

History of Postpartum depression or other depression/anxiety? Please elaborate and note any medications you are (or were) taking.

Will you and your spouse/partner pass a drug/nicotine screening throughout the process?

Yes

Maybe

Are you receiving welfare benefits, food stamps, or other government assistance other than a state offered health plan? If yes, from what sources are you receiving aid?

If you are not a stay-at-home mom, what line of work are you in? (Please elaborate)

Have you carefully read the Surrogacy Information Page and all topics of the FAQs?

Yes

I have additional questions not answered on the website.

By submitting this form, you agree to be contacted by Fertility Alternatives, Inc. regarding the surrogacy program.

If you believe you fully qualify, please check your spam folder for a Full Application email if you do not receive one in your inbox within 24 hours.

The information you have provided in this form will not be shared with any third-party. Though Fertility Alternatives and its employees do everything possible to keep all information confidential, the integrity and security of this form cannot be guaranteed over the internet.

Please add Dawn@FertilityAlternatives.com to your email Contacts/Safelist to receive further instructions

and a full application.

Fertility Alternatives®

ProCreate

Surrogacy and Egg Donation Programs

Since 1998

Surrogacy Preliminary Application
(This application is for Gestational Carrier candidates)

Surrogacy Preliminary Application (This application is for Gestational Carrier candidates)

Surrogacy Preliminary Application
(This application is for Gestational Carrier candidates)