Intended parents are required to complete a questionnaire which introduces him/her/them to the potential surrogate mother. The following questions may be included on your questionnaire:
Name and Age:
When and where were you born?
Where were you raised?
How many siblings do you have?
What order were you born? (youngest, eldest, only child?)
Is your mother living? Is your father living? Are all your siblings living? If not, at what age did they pass away?
List the gender and ages of any children you have and whether the children are from previous relationships:
Do you have legal and physical custody of all the above children? If no, please explain?
Does your family know of your plans for surrogacy? Are they supportive?
What is your occupation?
What is your educational background?
What are your hobbies?
Do you or have you ever:
Use narcotics or marijuana?
Have you ever been incarcerated for any reason?
Have you ever been in the military?
Have you ever, or are you now, under the care of a psychiatrist or counselor?
Have you ever been hospitalized for psychiatric care?
Have you had any significant or life threatening illnesses? What and when? Are you healthy now?
Are you currently in a relationship?
How long have you been with your partner?
How did you meet each other?
Where do you live?
Where is your home located? (city, the suburbs, or the country?)
How long have you lived there? Do you own or rent?
Please describe in detail what your home looks like. Describe size, a short description of the lay out, how many bedrooms it has, and how your home makes you feel:
Is your home located in reasonable distance from schools and parks and locations that children would enjoy?
If you have a faith or religious belief system, please describe:
How active are you in your faith or religious belief system? (church, bible-studies)
What are your family traditions for holidays and birthdays? (which ones do you celebrate, how do you celebrate, how involved is the extended family)
How does your family handle conflict or disagreements?
What are your reasons for choosing surrogacy?
How long have you wanted to do a surrogacy and when did you start looking for a surrogate mother?
Are you seeking gestational surrogacy or traditional, and why?
What procedure do you prefer to have used for conception, clinic, or home insemination if using Traditional Surrogacy?
What are your desires regarding being present during the birth of your child?
Please describe your parter. Describe his/her personality, what you like about him/her the most, what you might not like about him/her (if anything):
Describe what your partner looks like to you:
Describe your parter’s personality, from your point of view:
What kind of a parent will your parent be?
How do you feel about the surrogate staying in your home during conception and the pregnancy?
Is your family able to meet the financial needs of covering the surrogacy costs such as medical, legal, living expenses?
What expectations do you have regarding coverage of medical care, conception, legal expenses, clothing, and room & board for your surrogate?
If your doctor recommended an amniocentesis, how would you feel about this and would you want the SM to consent?
What are your views regarding abortion in the event that a baby is conceived and then is determined by a physician to have birth defects?
How many attempts would you be willing to try in order to conceive a child?
Are you willing to accept twins or triplets if a multiple birth occurred?
How do you envision your role during the pregnancy of your surrogate? Do you see yourself heavily involved in the pregnancy?
What do you think of filming and taking pictures from the time you meet your surrogate until the birth? How do you feel about filming and taking pictures of the birth of your child?
What amount of contact do you want with the surrogate once your child arrives? (pictures, letters, visits, phone calls)
What information do you plan on giving the child about the surrogacy once the child is older? What age do you plan on giving the child this information?
If your surrogate completes a successful surrogacy for you, and you become a parent, do you think you will want a sibling for your child? If yes, would you be likely to want to use the same surrogate?
What are your plans for childcare after the child is born? (daycare, stay at home mom or dad)
If the transfer or inseminatin fails, how soon would you want to try again?
If a surrogacy doesn’t work out, what do you plan to do next?