WOULD YOU BE A GOOD SURROGATE MOTHER? Take our quiz and find out now! Surrogate Quiz (APM Website) Would you find it rewarding and fulfilling to help someone achieve their dream of having a child?* Yes, it would feel wonderful to help someone out in such a special way No Unsure. I require more information to determine if this would feel rewarding to me or not Would you and your family benefit from receiving a MINIMUM of $40,000 in compensation, PLUS reimbursement for expenses, for your efforts? Yes No Unsure. I require more information to determine if this would feel rewarding to me or not Have you had at least one healthy, uncomplicated pregnancy and birth?* Yes No Unsure what qualifies as a "healthy pregnancy" Are you between the ages of 21 and 38?* Yes No What is your age range?* Under 21 39-40 Over 40 Will you be 21 within the next six months?* Yes No Have you given birth within the last two years? Yes No Do you have a BMI of 32 or below?*See chart above Yes No Almost What is your BMI? 32 33 34 35 or above Do you feel confident that you would be capable of reaching a BMI below 32 within 3 months?*Please be realistic about your lifestyle and goals Yes, I feel confident I am able to reach a BMI of 32 or lower within 3 months Willing to try, but I know it would be tough Probably not No Have you been a non-smoker and nicotine free for a least a year? (including the use of e-cigarette)* Yes No Almost Have you been completely nicotine free for at least 6 months?* Yes No Almost Have you been a surrogate mother before?* Yes No Congratulations on your surrogate journey! You automatically pass the quiz and can skip the rest of the questions. Just click "SUBMIT" to move on to the next step.Are you willing to abstain from recreational drugs and alcohol and make lifestyle modifications as requested?*No prescription drugs that are not prescribed to you. No illegal substances of any kind. No medicinal marijuana. No alcohol during the IVF process or the pregnancy Yes No Are you able to and willing to follow reasonable doctor’s instructions to help insure a healthy pregnancy and birth?* Yes No Unsure, I require more information Are you willing to take Doctor prescribed medications for several weeks to assist with the in-vitro process of getting and staying pregnant? This could include oral medications, patches, vaginal suppositories and/or injections.* Yes - I am willing to take medications because I understand this will greatly assist with the chances of a successful pregnancy No, I am not willing Unsure, I require more information Is your spouse or partner supportive of you being a surrogate?* Yes - My spouse/partner would supportive of my decision to be a surrogate mother Somewhat - My spouse/partner is somewhat supportive of me being a surrogate mother but needs more information Unsure – I’ve not spoken to my spouse/partner about surrogacy and want more information No - My spouse or partner would not be supportive of me being a surrogate mother I do not have a spouse or partner Do you have reliable transportation to be able to get to doctor appointments?* Yes No Public transportation What is your current situation regarding transportation?* I am temporarily without a vehicle but will have reliable transportation in the near future I do not need a vehicle because I live in an area with an efficient public transportation system and can easily get anywhere I need to go I have someone who always drives me wherever I need to go Not having reliable transportation has been an ongoing inconvenience Are you receiving welfare?* Yes No Beginning the surrogacy process could potentially prevent you from receiving government assistance, with no guaranty that you would continue to receive payments from surrogacy. Is that something you are comfortable with? Yes No Maybe Do both you and your spouse/partner have a clear criminal background?* Yes No Unsure What are the circumstances?* I have a felony on my record My spouse or partner has a felony on their record I have a criminal case pending My spouse or partner has a criminal case pending Misdemeanor only Traffic violations only I am currently on probation It was a long time ago, I'm not sure if it is off record yet Other Other - please explain*Has it been over 10 years since convicted?* Yes No Has it been over 5 years since convicted?* Yes No Is there currently any type of probation?* Yes No Do you have a stable home environment?*A stable home environment is a place where you and your family live where you are physically and emotionally safe, that is free from high levels of stress, and a place from which you do not plan to move in the next year. Yes No Unsure what is considered a stable home environment What is your US Residency Status?* Legal resident of the USA Temporary Resident Permanent Resident Card or Greencard Student Visa Not a legal resident Do you understand that as a gestational surrogate you would not be genetically related to the baby you would carry? Fortunately the surrogacy laws are now clearly defined for everyone’s protection so that once the baby is born you would not have any right or responsibility to the child* Yes, I understand I would have no right, obligation or biological relationship to the child No, I do not understand this I do not agree with this Δ
