Surrogate Inquiry

First Name:*
Last Name:*
Email*
Phone*
Address*
Street Address City State
Height and Weight (BMI)*
Age*
Any Pregnancy Complications?*
Do you have any health Insurance?*
Do you Smoke?*
Are you on any government assistance?*
Have you ever been arrested or convicted of a felony?*
Have you ever been a surrogate before?*
How did you hear about Positive Surrogacy?*
How many children do you have?*
- Yes, I meet all of the above requirements listed.

Thank you for your interest in being a surrogate with Positive Surrogacy.

You’re taking the first step towards giving an incredible gift.

In order to be considered for our Surrogate Program, you must meet the minimum requirements below.

Be between the ages of 21-38
Given birth to your own baby or babies.
No complications in last pregnancy
No convictions or felonies
Financially stable
Emotionally stable
Non-smoker
Non-drug user
Will agree to drug screening
Will agree to psychological screening
Responsible and healthy lifestyle
Healthy (BMI) body mass index
No history of mental illness
Flexibility to attend necessary appointments.
Living in CA, NV, or TX.
If you have had your tubes tied, you can still be a candidate for Surrogacy.

We Would Love To Speak With You

Please give us a call at (619) 354-7575 or contact us below