Bond Surrogacy Services

Follow the link to fill out a protected Online Profile or 

Cut, paste, and email your form to:

Surrogacy@BondEscrow.com

Bond Surrogacy Services

Office: 503-753-2429

Cell: 503-435-0633

2788 York Street, West Linn, Oregon

Surrogacy@BondEscrow.com

www.BondSurrogacy.com

PARENT #1

Name and Date of birth:

Email: 

Address:

Phone #

How many children do you have?

What is your occupation?

Have you ever been convicted of child abuse, domestic violence, animal abuse, fraud, threat, DUI/DWI?

Have you ever been hospitalized for psychiatric care?

Have you had any significant or life threatening illnesses? What and when?

Have you received counseling regarding assisted reproduction?




PARENT #2 (if applicable)

Name and Date of birth:

Email: 

Address:

Phone #

How many children do you have?

What is your occupation?

Have you ever been convicted of child abuse, domestic violence, animal abuse, fraud, threat, DUI/DWI?

Have you ever been hospitalized for psychiatric care?

Have you had any significant or life threatening illnesses? What and when?

Have you received counseling regarding assisted reproduction?

FOR BOTH PARENTS (where applicable)

Are you seeking a Gestational or Traditional Surrogate?

Are you seeking an Egg Donor?  Please describe the preferred qualities, personality and physical features you prefer for an Egg Donor:

How long have you been together/married?

How did you meet each other?


If you have a faith or religious belief system, please describe here:

What are your reasons for choosing surrogacy?

How long have you been seeking assistance via Surrogacy?

Are you ready to move on from current infertility treatments?

How do you feel about someone else carrying your child?

Are both partners ready to proceed with a surrogacy journey?

How will you explain the pregnancy and birth to others and eventually to your child?

Do you have an Assisted Reproductive Attorney, who?

Which Reproductive Endocrinologist/IVF clinic are you working with?

 
Are you able to meet the financial needs of covering the surrogacy costs such as medical, legal, pregnancy, travel, escrow, agency expenses?

Are you open to working with a single stable Mom or married Surrogate?

Do you prefer a first time Surrogate or experienced Surrogate?

 Are you willing to work an out of state surrogate by providing transportation for required clinic appointments and transfer?

 What, if any genetic testing are you planning?

 Will you require abortion/selective reduction for multiples or birth defects?

Are their race, sexual orientation, or religion restrictions you do not wish to work within your Surrogate or Egg Donor?  Please list:

How do you envision your roll during the pregnancy of your surrogate? Do you see yourself heavily involved in the pregnancy, able to attend the “big” appointments, or not able to attend any/most of the appointments?

Are you willing to pay for a "Surrogate Friendly" health insurance plan including deductibles and copays for your Surrogate?

What amount of contact do you want with the surrogate once your child arrives? (I.e., pictures, letters, visits, phone calls)

**Please attach a couple of photos you’d like to share