Full Legal Name
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Preferred Name
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Phone
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(###)
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Date of Birth
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MM
DD
YYYY
Age
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Citizenship(s)
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Occupation(s)
Full Legal Name
Preferred Name
Date of Birth
MM
DD
YYYY
Age
Citizenship(s)
Occupation(s)
General health of Intended Parent(s):
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Do you have embryos created? If so, how many? Are they PGS tested?
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Are you using your own eggs or donor eggs? If using a donor, is it a known donor?
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If necessary, are you willing to create more embryos?
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Which fertility clinic are you working with?
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Are you working with a fertility lawyer already? If so, please provide their name.
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How did you hear about Fearless Surrogacy?
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Why do you want to use a Surrogate?
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Parents
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Friends/co-workers
Would you like to attend obstetrical appointments with your Surrogate? If yes, are there specific appointments you would like to attend?
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Please include if you would like to attend in person/virtually.
What are your thoughts on termination of a pregnancy due to genetic abnormalities or complications related to the pregnancy? Are there specific instances you may wish to not terminate? Please provide as much detail as possible.
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If your Surrogate becomes pregnant with multiples, how would you feel? How do you feel about the possibility of selective reduction being recommended due to a multiple pregnancy?
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Are you vaccinated for Covid-19? Do you have a preference for a Surrogate to have been vaccinated for Covid-19?
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What kind of relationship do you want to have with the Surrogate during the pregnancy?
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What kind of relationship do you hope to have with your Surrogate after the birth of your child?
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Do you want to be in the delivery room when your child is born?
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What will you tell your child about the Surrogate, and the circumstances of their birth?
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If the child asks to meet the Surrogate, how will you feel?
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If the transfer is unsuccessful, will you want to try again? If so, how soon after?
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Would you be open to midwifery care instead of obstetric care?
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Would you be open to a homebirth?
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Would you like your Surrogate to provide breastmilk?
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If the surrogacy journey is successful, would you want to complete a sibling journey? What do you envision that looking like? (timeline, same Surrogate etc.)
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What are your plans for childcare once the child is born?
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What does a typical weekend look like for you?
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What are some of your interests/hobbies/activities?
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Do you have pets?
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Share their names.
Favourite foods/meals?
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Share any other fun facts!
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You might include your favourite sports teams, childhood memories, favourite places to travel, special talents etc.
Please include any other information you would like to share with us, and/or potential Surrogates.
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This should be a few sentences to a short paragraph. You might include a bit about your personality, your values, your love story, hopes and aspirations etc.
On Fearless Surrogacy social media (Facebook, Instagram, TikTok, YouTube etc.) I would like:
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What personal information are you comfortable sharing on social media?
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location, nationality, personal story, family, history etc.
On Fearless Surrogacy website?
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What personal information are you comfortable sharing on our website?
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location, nationality, personal story, family, history etc.
Your names, pictures, videos and personal information will be shared on our password protected database for only Surrogates to review. Is there information you would NOT like shared here?
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