Potential Surrogate Interest Form - Become a Surrogate

Ready to get started or receive more information? Fill out our brief intake form below and we will be in touch!

First name

Last name

Street address

City

State

Zip/postal code

Primary phone number

Birthdate

Height (feet)

Height (Inches)

Weight (lbs)

Number of pregnancies resulting in live birth(s)

Number of cesarean sections

Number of miscarriages

Do you have Native American heritage?

Have you ever taken medications for depression or anxiety?

Do you smoke?

Have you undergone a sterilization procedure called Essure (metal coils) or Adiana (silicone plugs)?

If the intended parents found out that something was medically wrong with the baby and wanted you to terminate the pregnancy, would you be willing to do so?
How did you hear about us?

If you were referred by a friend or family member, what is that person’s name?

Surrogacy with NWSC during COVID-19

NWSC is committed to helping families achieve their dream of parenthood through surrogacy while also prioritizing everyone’s health and safety. We understand families and surrogates may have waited years to start this process, and we are ready to help you with your journey. Check out our frequently asked questions about surrogacy with NWSC during this unique time.

Are NWSC offices open?
Yes, most NWSC employees are working remotely, and all meetings are being held over Zoom. We continue to be available during normal business hours, Monday through Friday, 8 AM – 5 PM PST.

Can I still start my surrogacy journey as an intended family?
Yes, potential surrogates can complete the screening process virtually and are available to match with families. If you are interested in finding out more, the first step is to schedule a free, initial consultation over Zoom here. When you are ready to get started, the NWSC fee agreement can be emailed and signed electronically.

Can I become a surrogate during COVID-19?
Yes, we are excited that so many wonderful women are contacting us to start their surrogacy journey and help a deserving intended family have a baby. We are completing the screening process over email, phone, and Zoom. If you are ready to find out more, please complete our online intake form.

Can I be matched?
Yes, we have many loving families and generous surrogates ready to be matched. Surrogates are able to undergo all the screening steps virtually, and we are matching them as soon as they complete that process. Match meetings are held over Zoom, and surrogates and families are also working on their legal contracts as they normally would after a successful match meeting.

Are clinics open?
Clinics are closely monitoring local orders and have implemented social distancing procedures. So the process looks a little different than before COVID-19, but medical screenings and embryo transfers are taking place.

Please don’t hesitate to reach out any time, and you can reach us at info@nwsurrogacycenter.com. We hope you are healthy and safe.

Sincerely,

The NWSC Team

Learn more about surrogacy with NWSC during the COVID-19 pandemic.

Potential Surrogate Mother Interest Form

Ready to get started or receive more information? Fill out our brief intake form below and we will be in touch!

Contact Us