Surrogate Questionnaire: Getting to Know You Questions
Names of surrogate and spouse, ages
How many children do you have? Do you have legal custody of all of your children? Tell us about your children.
Do you want to have any more children?
Where are you from?
What do you do for a living? Your husband/partner?
How long have you been together?
Why did you decide to become a surrogate mother?
Does your family know that you are thinking of becoming a surrogate mother?
What religion are you? What are your religious beliefs?
Describe your personality. What are your interests? Hobbies?
Has anyone in your household ever been arrested or convicted of a crime? Please explain.
Traditional Surrogate Specific Questions
Physical characteristics including height, weight, hair and eye color, heredity.
What was your high school GPA? Do you know your IQ score? How about ACT or SAT scores? What sort of extracurricular activities were you involved with?
Did you attend college? What did you study? What was your GPA?
Do you have any learning disabilities?
Are both your parents living? What about your grandparents? Siblings? If not, how did they pass away? How old were they?
What kinds of medical conditions are prevalent in your family? Does your family have a history of cancer, heart disease, genetic birth defects?
Surrogate Questionnaire: Health Questions
How many pregnancies have you had? Were they easy pregnancies? Any complications during the pregnancies or births?
Have you had any miscarriages? How many? When?
Were your children born healthy?
What medications are you currently taking?
Do you have any conditions or illnesses which may prevent you becoming pregnant or which may affect your ability to carry?
Have you ever been under psychological care, or hospitalized for psychiatric reasons?
Do you have a history or have you ever been treated for any drug or alcohol related issues?
Do you smoke? If you drink recreationally, do you have any problem with abstaining from alcohol during your pregnancy?
When was your last check up with your doctor?
Do you have any STDs, including herpes or HPV?
What forms of birth control are you currently using?
If bed rest was recommended by your doctor, would this be a problem?
Surrogate Questionnaire: Previous Surrogacy Experience
Have you ever been a surrogate mother before? If yes, please describe your previous commercial surrogacy journeys.
How many IVF attempts (or cycles) are you willing to try in order to achieve a surrogate pregnancy?
How many embryos do you foresee implanting during each attempt? (gestational surrogacy)
What are your feelings on becoming pregnant with twins or triplets?
What are your feelings on selective reduction?
What are your feelings on abortion if it was found that a child was found to have birth defects?
If an amniocentesis was recommended, would you be willing to have one?
How do you feel about traveling out of state for the embryo transfer? (gestational surrogacy)
How would you feel about doing home inseminations? (traditional surrogacy)
Do you think it will be difficult for you to give the child back to his parents? Please explain.
What sort of support system do you have in place for surrogate pregnancy?
How does your partner feel about commercial surrogacy? Does he realize that he will need to be involved in testing, possibly medicine administration, and supportive of you throughout the journey?
Surrogate Questionnaire: During the Pregnancy
What kind of contact do you foresee having during the surrogate pregnancy? Do you want us to attend every doctor's appointment? Or would you only like us to attend ultrasounds, or no appointments at all?
Who would you want present at the birth? If a c-section was required, who would you want to be present?
How do you feel about various forms of publicity?
Would you be comfortable with having the birth videotaped?
Surrogate Questionnaire: Financial Questions
What are you looking for as far as commercial surrogacy compensation? Do you have a set figure in mind?
Is this amount negotiable?
Surrogacy Questionnaire: After the Surrogate Pregnancy
What kind of future contact do you expect to have with your intended parents or the baby? (calls, pictures, meetings, etc)
How would you feel if the child wanted to meet you?
How do you feel about pumping breast milk for the baby? For how long would you be willing to do so?
Would you be interested in doing a second surrogacy in the future as a sibling project if the first surrogacy worked out? How far into the future? (one year, three years, right away, etc)
It's also important to include questions in your surrogate questionnaire that might reflect your personal or religious feelings. Do you only want to work with surrogate mothers who are stay at home moms? That's fine. How about finding a surogate mother who is your specific religion? That's OK too.
What is not OK is to rush the matching process because you are eager to get started, only to find yourself in a situation where you are compromising your feelings and beliefs.
Despite what you may be feeling emotionally, there are plenty of surrogate mothers out there just waiting to answer your surrogate mother wanted ad. Take your time, use this surrogate questionnaire, and find the right woman for your commercial surrogacy journey.
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