Application / Information - Egg Donor

IP - unique ID
SUR - unique ID
ED - unique ID
I am interested in?*
- Becoming a Parent
- Becoming a Surrogate
- Becoming an Egg Donor
- Other (i.e. financing, etc.)
Name*
First Middle Last
Email*
Username*
Please select a USERNAME that you will use in the future to access your account . . . a PASSWORD will be emailed to you upon account activation.

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INTENDED PARENT REQUEST FORM
SURROGATE APPLICATION
Welcome to our easy online application, which will help determine if you meet our minimum qualifications to become a surrogate.
EGG DONOR APPLICATION
Welcome to our easy online application, which will help determine if you meet our minimum qualifications to become an egg donor.
OTHER (i.e. financing, etc.) - INFORMATION REQUEST FORM
Personal / Contact Information
I/we are interested in becoming a parent(s) via*
(check all that apply)
- Surrogacy Program
- Egg Donor Program
Marital / Family Status*
No. of Children (presently)
Date of Birth*
Partner's Name (if applicable)
First Middle Last
Spouse or Partner's Name (if applicable)
First Middle Last
Spouse or Partner's Date of Birth (if applicable)
Address*
Street Address Apt / Suite # or Address Line 2 City State / Province / Region ZIP / Postal Code Country
How many years have you lived at this address?*
Home Phone
Can we leave private messages on this number?
- Yes
- No
Work Phone
Can we leave private messages on this number?
- Yes
- No
Cell Phone*
Partner's Cell Phone (if applicable)
Can we leave private messages on this number?
- Yes
- No
Best Number To Be Reached At*
Partner's Email (if applicable)
How did you hear about us?*
If you selected 'Referral-Doctor,' 'Referral-Friend', 'Referral-Other' or 'Other' above, please tell us the name of the person who referred you and/or describe.
If you selected 'Referral' or 'Other' above, please tell us the name of the person or source who referred you.
Emergency Contact Information
Emergency Contact Name*
First Last
Emergency Contact Phone*
Emergency Contact - Relationship to You (i.e. spouse, friend, etc.)*

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INTENDED PARENT REQUEST FORM
Agency Questionnaires
How soon are you looking to start your surrogacy journey?
Do you already have any frozen embryos? If yes, how many?
If you have frozen embryos, are they PGS tested?
Do you already have an egg donor you would like to use?
If not, are there any specific traits/characteristics/ethnicity you are looking for?
Are you OK with having no contact from the egg donor if she wants to stay anonymous?
Do you need a sperm donor?
If not, who will be donating? (IP1, IP2, both, other- please explain)
Are you planning on doing PGS testing on your embryos? (if yes please explain e.g. gender selection, genetic purposes)
Do you have a specific Fertility Clinic you have worked with or would like to use? (Agency Note: We can work with any health care provider you desire. If you do not have one, SLS has quality options to recommend)
Do you have a specific family formation attorney that you would like to use? If not, we can help recommend you to our network of attorneys.
Have you executed any kind of surrogacy agreements in the past?
Do you have any of the following applications for communication purposes during your journey to parenthood (Skype, WeChat, or WhatsApp)? Please indicate which one and provide your account ID information.
Questionnaire for Surrogate Matching
How long have you been with your partner?
Do you have any other children?
What languages do you speak?
Do you speak and/or write English? If no, are you open to paying for translation services?
What are your professions? (include spouse if applicable)
What are your religious beliefs? (include spouse if applicable)
Briefly describe your personality. (include spouse if applicable)
What are your hobbies and/or interests? (include spouse if applicable)
What is your favorite food?
What is your favorite music?
What is your favorite movie?
What is your favorite vacation spot?
Does family support you on your surrogacy journey?
What attributes are you looking for in the surrogate who will be assisting you through your journey?
What are your personal reasons for choosing surrogacy to have a family?
What is the name and location of your IVF clinic?
Are your embryos PGS tested? If yes, how many were tested?
Do you prefer to have a singleton or twins?
Do you have a preference of a boy or a girl?
If more than your maximum were conceived would you want selective reduction to reduce the number of fetuses?
If severe abnormalities were found in a fetus would you abort the pregnancies?
Would you like to attend doctors appointments? If no, please explain.
What kind of a relationship would you like with a surrogate? How much involvement would you like during the pregnancy?
To the best of your knowledge do you or your partner have any health conditions? (Examples: Diabetes, high blood pressure, STDs, HIV, Hepatitis A,B or C)
During the surrogacy process, how much and what kind of contact would you want from your surrogate? (Monthly, weekly, email, phone calls, in person if possible, etc.)
After the surrogacy process is completed, what level of contact and relationship would you like to have with your surrogate? (ex. Email, photos, text messages, or none)
If it’s possible, would you like to be present in the delivery room during the birth of your child?
Surrogates usually want to know more about the intended parents that they will be working with. Please provide any other information that may help a surrogate choose you.
Please upload a few photos of you and/or your spouse. Photos would be used to create your profile for our surrogate's matching process.
Drop files here or
Are you ready to schedule a consultation?*
- Yes
- No
Comments or Questions

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SURROGATE APPLICATION
Welcome to our easy online application, which will help determine if you meet our minimum qualifications to become a surrogate.
Interests
What is your favorite book/author?*
What is your favorite type of music?*
What is your favorite movie?*
What is your favorite TV show?*
What are your favorite foods to eat?*
What is your favorite restaurant?*
What is your favorite color*
What is your favorite flower?
Do you have any hobbies?*
Do you collect anything special?*
What type of jewelry do you like to wear/like?*
Where would you most like to travel and why?*
What is your favorite thing to do in your spare time?*
What do you like doing most with your family and/or friends?*
What are you/and partner’s favorite sports teams?*
What is your ultimate goal or life’s ambition?*
What would you use the compensation you would receive from becoming a surrogate mother for?*
What do you think is the biggest stress in your life at present?*
How would you describe yourself?*
What makes you angry?*
What makes you feel happy?*
When do you get down (or depressed)?*
Describe your sense of humor?*

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SURROGATE APPLICATION
Welcome to our easy online application, which will help determine if you meet our minimum qualifications to become a surrogate.
Compatibility
SLS is a gay community focused agency. Most likely your IP's will be a same sex couple. Would you be comfortable with this?*
- Yes
- No
Describe your ideal intended parents for whom you would like to be a surrogate? What would you especially like the child/children to know about you?*
What do you think of communication with IPs using email? Would you be able to check your email regularly?*
Would you like to communicate with your IP’s through phone calls or texts? Yes If so, how often?*
How much involvement from your IP’s do you want during the pregnancy?*
Would you be willing to have your IP’s present at the transfer(s) and doctor appointments?*
- Yes
- No
How do you feel about the Intended Parents being in the delivery room with you?*
Is there anyone else you would like to have in the delivery room?*
How do you feel about pumping breast milk for your IP’s to give to their baby(babies) for compensation?*
Some Intended Parents don’t live near their surrogates. How do you feel about having IP’s that cannot attend doctor appointments and see you on a regular basis?*
Would you be willing to work with single Intended Parents?*
Would you be willing to work with HIV positive parents if their sperms are clinically cleaned of the virus?*
Would you be willing to have embryo transfer in another state?*
Would you need to bring your partner when you need to travel for surrogacy?*
When are you ready to begin?*
What kind of relationship would you prefer with the Intended Parents after the birth of the child(ren)?*
How do you feel about the possibility of carrying more than one baby as a surrogate gestational carrier? Would you be willing to carry twins?*
If medically recommended (due to quality of life or possible death after birth), are you ok with terminating the pregnancy up to 24 weeks gestation?*
Are there any specific conditions in which you would not terminate a pregnancy? If yes (conditions not to terminate), please explain.*
As a surrogate, what reassurance can you give that you will not change your mind about relinquishing the child?*
Is there anything you would like to add or say to potential Intended Parents that was not included in this questionnaire? Please use the space below and other side of this page if needed.*

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Other (i.e. financing, etc.) - INFORMATION REQUEST FORM
Comment or Question*
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Comments
This field is for validation purposes and should be left unchanged.

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INFORMATION / APPLICATION

Same Love Surrogacy - Information Request / Application Submission

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