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Surrogate Application

Make a difference in someone’s life in a remarkable way

Continue to work, or stay at home with your little ones, while earning money to achieve your personal goals

Match with Intended Parents you choose

Home / Our Surrogate Program / Surrogate Application

Surrogacy Application


  • General Information
  • FAQ
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Register to View Surrogates

Call Us: 800-551-1445

Email Us: info@familycreations.net

Surrogacy Application

"*" indicates required fields

1Basic Information
2Health History
3Medical History
4Personal History
5Confirmation

Tell Us About Yourself

Email*
MM slash DD slash YYYY
Is it okay to leave a message to the best contact?*
Is it okay to leave a message to the second contact ?
Please enter a number less than or equal to 12.
Please enter a number less than or equal to 12.
Are you currently enlisted in the Military*
Is your spouse currently enlisted in the Military*
Are you currently employed*
Do you have your high school diploma or GED*

Tell Us About Your Health History

Have you given birth before*
Have you delivered a child vaginally*
Have you had a cesarean (c-section)*

Please specify if you have had any of the following complications throughout any of your past pregnancies:

Placenta Previa*
Toxemia*
Pre-Eclampsia*
Anemia*
Pregnancy-induced hypertension*
Gestational Diabetes*
Have you been a surrogate mother before*
Do you smoke or use tobacco*
Have you used any illegal drugs in the past 12 months*
Have you ever been a member of a drug or alcohol treatment program*
Have you or your partner tested positive for Chlamydia in the past 12 months?*
Have you or your partner tested positive for Gonorrhea in the past 12 months?*
Have you or your partner tested positive for Syphilis in the past 12 months?*
Have you or your partner tested positive for HIV/AIDS?*
Have you ever been diagnosed with Genital Herpes?*
Have you received a tattoo in the past 12 months?*
Have you received a piercing in the past 12 months?*
Do you currently have health insurance?*

Tell Us About Your Personal History

Are you currently receiving any type of government assistance?*
Have you ever been arrested?*
Have you ever received a DUI or DWI?*
Have you or your partner ever been convicted of a felony?*
Have you ever been diagnosed as clinically depressed?*
Have you ever been diagnosed with post-partum depression?*
Have you ever been prescribed anti-depressants?*
Have you ever been prescribed anti-anxiety medication?*
Have you ever attempted suicide?*
Have you ever had a child removed from your home?*
Have you ever lost custody of a child?*
Have you ever been a victim of domestic violence?*
If your application is approved are you (and your spouse if applicable) willing to have a full background check conducted and released to Family Creations?*
Are you willing to undergo a home visit conducted by a Family Creations staff member?*
Please upload a recent photograph of yourself. Applications with photographs submitted will be processed faster.
Accepted file types: jpg, jpeg, png, gif.
I agree that I represent that all written representations and information provided and/or to be provided to Family Creations, LLC, and any professional, psychologist, physician, physician's assistant, nurse, attorney, or designee of Family Creations, are true, correct and complete.*

Confirmation

Thank you for your interest in Family Creations. Please create a password. You will use this password to login to your account, update your profile and submit required documentation
Password*

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Welcome to the new Family Creations Website!

Welcome Back! With over 15 years of experience, Family Creations is a pioneer when it comes to egg donor and surrogate arrangements. You may notice we gave our website a facelift and made some updates to make your user experience better.