Surrogate Intake Page
Please refer to the list below to help guide you through the intake process.
Please complete all the forms listed below and provide copies of the requested documentation.
If you need help filling out or have questions, Amber is glad to help.
Amber 458.207.0523 (text friendly)
Surrogate
Please complete the following quick forms, starting with Section 1 and
moving onto the next section until you complete all the six sections.
Section 2
We need to order your medical records from each of your pregnancies and deliveries. If you have any concerns, or can't remember the name or address of your clinic, reach out to us and we will help!
Please click the link below.
Authorization to Release Healthcare Information
Fill out the information for each pregnancy on the form. Please include the prenatal care provider and the delivery hospital or facility for each pregnancy.
Please make sure to list the year before you delivered and your delivery year. (For example, if you delivered a baby in April of 2015, you would put "2014 & 2015" in the year section.)
Section 6
Please email an image/photo of each of the following documentation to:
Please email an image/photo of each of the following documentation to:
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Surrogate Front and Back of Photo Identification
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Surrogate Front and Back of Health Insurance Card
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Surrogate Copy of Health Insurance Booklet
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Surrogate Pay Stubs (2 most recent)
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Please email 10-20 photos of you, your partner, your family, your home, etc. (Please use photos that give us an idea of who you and your family are…candid is great, posed are ok. A variety is best.) We will use these photos to build your profile to show intended parents.
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Surrogate Spouse/Partner Front and Back of Photo Identification
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Surrogate Spouse/Partner Pay Stubs (2 most recent)