Become a Surrogate at RSW Fertility

Estimated completion time:
3-5 minutes

Welcome👋🏼 and THANK YOU for your interest in becoming a gestational surrogate. The application process consists of three simple phases:

Prescreen Questionnaire: Start by completing the short prescreen questionnaire below. This helps us confirm that you meet the basic qualifications to move forward.
Schedule a Call: Once you submit your prescreen, you’ll be automatically prompted to schedule a call with me. During this call, we’ll walk through the process together, answer any questions you have, and make sure you feel fully informed and comfortable moving forward.
Full Questionnaire: After your call, you’ll be invited to complete the full questionnaire. This is a more in-depth look at your background and experience, and gives us the opportunity to really get to know you.

So go ahead, get comfy, and start with the prescreen below. I'm excited to connect with you soon.

Kayla Thompson💖RSW Intake Coordinator

Already started an application? Sign In

1. What is your First Name? *

2. What is your Last Name? *

3. Do you have a nickname or a name you go by more frequently?

4. What is your primary phone number? *

5. Do we have your permission to text and/or leave voice messages at this number? *

6. How would you prefer we get in touch with you? *

Phone
Text
Email
Any of these options

7. What is your date of birth? *

8. What is your height? *

9. What is your weight? Please BE AS ACCURATE AS POSSIBLE as this will be verified. *

10. What state do you live in? *

11. Are you a US citizen? *

12. What is your current relationship status? *

13. What is your current method of birth control? *

14. When was your most recent Pap Smear screening? *

Estimated completion time:
3-5 minutes

Welcome👋🏼 and THANK YOU for your interest in becoming a gestational surrogate. The application process consists of three simple phases:

Prescreen Questionnaire: Start by completing the short prescreen questionnaire below. This helps us confirm that you meet the basic qualifications to move forward.
Schedule a Call: Once you submit your prescreen, you’ll be automatically prompted to schedule a call with me. During this call, we’ll walk through the process together, answer any questions you have, and make sure you feel fully informed and comfortable moving forward.
Full Questionnaire: After your call, you’ll be invited to complete the full questionnaire. This is a more in-depth look at your background and experience, and gives us the opportunity to really get to know you.

So go ahead, get comfy, and start with the prescreen below. I'm excited to connect with you soon.

Kayla Thompson💖RSW Intake Coordinator

Already started an application? Sign In

1. Have you contributed to world population growth by having at least one baby? *

1a. What is your total number of pregnancies? *

1b. How many of your deliveries were by cesarean section? *

1c. Have you delivered any pregnancies prematurely (prior to 37 weeks)? *

1d. What is your total number of pregnancies resulting in live birth? *

1e. Please provide the following information on all live births. *

	Birth Month & Year	Delivery Type	Weeks of Gestation	Sex	Weight	Complications?
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
Child 8
Child 9
Child 10
	Add Row

2. Have you experienced pregnancy loss (i.e. miscarriage, abortion, etc.)? *

2a. Please provide the following information on all pregnancies that did NOT result in live birth. *

	Year of conception	Weeks of gestation	Outcome	Complications?
Pregnancy 1
Pregnancy 2
Pregnancy 3
Pregnancy 4
Pregnancy 5
Pregnancy 6
Pregnancy 7
	Add Row

Please provide additional details.

3. Pregnancy can be tough. Aside from normal aches and pains, did you have any notable complications? *

4. Are you or any of your household family members on any form of government assistance (WIC, Medicaid, food stamps, etc.)? *

5. Have you been a surrogate or egg donor before? *

No
Yes-Surrogate
Yes-Egg Donor
Yes-Both

6. Are you applying to All Families Surrogacy or IARC Surrogacy? *

7. How did you hear about us? *

Last Step: Create your account to submit your information

Preferred Email Address

Email Address

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One special character (e.g. * or !)

Questionnaire

Become a Surrogate with RSW Fertility

Become a Surrogate with RSW Fertility

Last Step: Create your account to submit your information