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Surrogates
Blogs
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About Us
Intended Parents
Surrogates
Blogs
Contact Us

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Contact Us

1 Marcus Boulevard, Suite 200
Albany, New York 12205
1-866-444-6972
1-866-444-NYSC
Fax: 518-436-1456
office@NYSurrogacyCenter.com
License Number GSP2111000

Zoom Meetings Available

Get Startedhal2023-04-19T16:36:26-04:00

Intended Parent Inquiry

If you are a potential intended parent interested in learning more about surrogacy and New York Surrogacy Center, please complete and submit this form. Once you submit this form, we will contact you by the next business day.

Name 1 *

First

Last

Name 2

First

Last

Fertility Clinic (write “None” if not yet selected) *

Marital Status *

State of Residence *

Are one or both of you US citizens or legal permanent residents? *

Phone Number 1 *

Phone Number 2

Email 1 *

Email 2

How did you hear about us? *

Email

1 Marcus Boulevard, Suite 200
Albany, New York 12205
1-866-444-6972
1-866-444-NYSC
Fax: 518-436-1456
office@NYSurrogacyCenter.com
License Number GS211000

Zoom Meetings Available

Servicios de traducción e interpretación en español disponibles para clientes.
Spanish translation and interpreter services available for clients.

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Surrogates: Apply Today

Surrogates: Do I Qualify?

Do I Qualify?

Answer the questions below to see if you qualify to act as a surrogate!

Are you between the ages of 21 and 44? *

Yes
No

Are you a US citizen or legal permanent resident? *

Yes
No

Have you had at least 1 full term (37 weeks) pregnancy without significant complications? *

Yes
No

Have you had less than 6 deliveries? *

Yes
No

Have you had less than 4 C-sections? *

Yes
No

Have you had less than 2 miscarriages? *

Yes
No

Have you had less than 2 stillbirths? *

Yes
No

How tall are you? *

How much do you weigh? *

Do you have any current/active STDs or STIs? *

Yes
No

Please specify (not all are disqualifiers): *

Have you suffered from post-partum depression requiring medication? *

Yes
No

Have you taken any medications for mental health purposes (ex. anxiety, depression) within the last 6 months? *

Yes
No

Are you currently taking them? *

Yes
No

Are you comfortable coming off of them for a surrogacy pregnancy? *

Yes
No

Do you currently smoke cigarettes or use other tobacco/nicotine products? *

Yes
No

Have you ever been convicted of a crime? *

Yes
No

Please specify the crime and the circumstances surrounding the incident: *

Have you ever been found to have abused or neglected a child? *

Yes
No

Please describe the incident that led to this finding: *

Congratulations! It sounds like you would make a great surrogate! PLEASE SUBMIT THIS FORM and we will reach out to your soon to send you some information on surrogacy and to see if you’d like to set up a time to chat about moving forward with surrogacy.

Thank you for taking our surrogate eligibility quiz! Some of your answers require further review before we can let you know whether you will be eligible. PLEASE SUBMIT THIS FORM and we will reach out to you soon to chat about your answers.

Name *

First

Last

Phone *

Email *

Intended Parents: Get Started Today

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