Surrogate Pre-qualification Form

Becoming a Surrogate Starts Here

It only takes 5 minutes to find out if you qualify to become a surrogate! Fill out the form below to start your pre-qualification screening. An International Surrogacy Center team member will reach out shortly with more information for qualified candidates.

GENERAL INFORMATION

First Name: *

Last Name: *

Email Address: *

Create a password for future logins: *

Phone: *

By entering your number, you agree to receive mobile messages.

Country: *

You must be a US resident to be a surrogate with ISC

Address 1:

Address 2:

City:

State:

You must be a resident of the United States to be a surrogate with ISC

Zip:

Are you a US citizen?: *

Are you a permanent resident?: *

You must be a US citizen or permanent resident to move forward in the application process.

Age: *

You must be 21 and over to be a surrogate with ISC

Our surrogates are almost always under 40 to prevent potential complications associated with older births

Marital Status: *

How long have you been separated/divorced?: *

How many children have you given birth to?: *

You must have given birth and be raising at least one of your own children to be a surrogate with ISC.

Number of births given by each of our surrogates is always under 6.

How many C Sections have you had?: *

For the safety of our surrogates and the babies, we cannot accept candidates with a history of high-risk pregnancies.

Are you currently breastfeeding?: *

When do you plan to stop?: *

What is your height?: *

What is your weight? (example: 172): *

Health Insurance?: *

Have you or your partner (if applicable) been convicted of a felony?: *

I'm sorry we cannot move forward in the application process if you or your partner have been convicted of a felony.

Are you (and your partner, if applicable) willing to participate in a criminal background check?: *

All surrogate candidates and their partners (where applicable) must be willing to have a criminal background check

Do you currently use any tobacco/nicotine products?: *

I'm sorry we cannot move forward in the application process until you have been tobacco/nicotine free for at least 6 months.

Are you currently receiving any government financial aid?: *

If so, what kind?:

Do you have your own vehicle and drivers' license?: *

Have you been a surrogate before?: *

How soon are you ready to become a Surrogate?: *

Please enter your questions or comments:

(619) 591-9113

OUR GOAL IS TO MAKE THIS THE HAPPIEST TIME OF YOUR LIFE.

Becoming a Surrogate Starts Here

GENERAL INFORMATION