You are confirmed! I’m so excited to connect with you and learn more about you.

Before we chat, please take a few minutes to fill this out; it’ll help us make the most of our time together.

Full Name

Phone *

Email *

Date of birth

Marital Status

Partner's Name (if applicable)

Do you have children?

If yes, please share anything that would relevant to know (I.e., use of surrogate, reproductive technology, natural conception, etc)

Reasons for considering surrogacy:

Would you be using the assistance of an egg or sperm donor?

Are you considering an agency or independent journey?

What are you hoping to achieve during our initial consultation?

Please use the text box below to share any additional information that would be helpful in preparation for our meeting.

May we use AI note-taking (your info remains confidential)? We respect your choice either way!

Stay informed and be part of our community!

I'd like to receive Surrogacy Simplified's monthly newsletter.

Jane Doe

Founder/CEO, XYZ Inc.

Jane Doe

Founder/CEO, XYZ Inc.

Call/Text: 410-457-3794

Email: [email protected]

Site: www.surrogacysimplified.com