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INTENDED PARENTS
LGBTQ+ PARENTS
ESTIMATED COSTS
FINANCING OPTIONS
APPLICATION FOR INTENDED PARENTS
INTENDED PARENT QUESTIONNAIRE
SURROGATES
9 STEPS TO SURROGACY SUCCESS
COMPENSATION
APPLICATION FOR SURROGATES
SURROGATE QUESTIONNAIRE
SURROGATE MOTHER REFERRAL
ABOUT
CONTACT
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YOUR CART
SURROGATE / GESTATIONAL CARRIER APPLICATION - $700 Signing Bonus
*
Indicates required field
Name
*
First
Last
Email
*
Phone Number
*
If this is a cell phone number are you comfortable receiving notifications via text messages
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Yes
No
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Spouse/Partner Name
*
First
Last
Are you an experienced Surrogate
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Yes
No
Date of Birth
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Total Number of Times You Have Been Pregnant
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Number of Live Births
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Have You Had Any Pregnancy Complications
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Yes
No
If yes, please explain
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Have you ever undergone any fertility treatments (medications, insemination, IVF, acupuncture, etc.) to become pregnant
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Yes
No
If yes, please explain
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Dates of Live Birth(s) and Hospital
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Do you have Medical Insurance
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Yes
No
If yes, which insurance carrier
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Height
*
Weight
*
Are you taking any medications
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Yes
No
If yes, please explain
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Have you ever been diagnosed or treated for any emotional disorder(s)
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Yes
No
If yes, please explain
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Do You Smoke
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Yes
No
Are you around anyone who smokes
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Yes
No
Do You Use Drugs
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Yes
No
Do you have any criminal arrests
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Yes
No
If yes, please explain
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Are you receiving any public assistance
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Yes
No
If yes, please explain
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Are you available to travel if needed
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Yes, I can travel anywhere
Yes, but only in my state of residence
No
Preferred Language
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English
Spanish
Other
How did you hear about Star Surrogacy
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Google
Family/Friend*
Fertility Clinic
Facebook
Instagram
Other Social Media
Other Internet Search
Other
If you were referred please tell us who referred you
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By selecting “Agree”, you understand the following: Some of the questions in this application are very personal. No answers will be shared with anyone outside of Star Surrogacy without your permission. Certain questions and answers are not shared with recipients and are only used for our internal purposes.
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Agree
By selecting "Agree", you are stating that you understand the treatment involves a psychological evaluation, medical testing, a legal contract drafted by an attorney, and frequent visits to a fertility center. You may need to administer injections to yourself daily, for a period of weeks. You will also undergo blood draws and vaginal ultrasounds at the fertility clinic. Becoming pregnant as a surrogate is not a simple process.
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Agree
By selecting "Agree", you are stating that you will and you have answered all questions to the best of your ability, without purposeful omission or deception. You understand being a surrogate is a serious responsibility and a process that requires maturity, excellent communication, honesty and a willingness to help others
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Agree
Comments/Questions
*
Submit Application
