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VELASurrogacy

Surrogate Interest Form

We’re so glad you’re here.

Surrogacy is an extraordinary choice—one rooted in generosity, strength, and trust. Every surrogate's journey begins differently. Some women arrive knowing this is something they want to do. Others are simply looking for answers. Wherever you are in that journey, you'll be met with honest information, thoughtful guidance, and genuine support. If becoming a surrogate is the right path for you, we'll be honored to walk beside you.

Complete the interest form below to connect with us. Everything you share is confidential, and there's never any obligation. We’d love to get to know you.

1.Contact Information

Preferred Method of Contact

2.Basic Eligibility

Are you a U.S. citizen or permanent resident?
Do you currently live in the United States?
Do you have reliable transportation?

3.Pregnancy History

Have you given birth to and are you currently raising at least one child?
Were your deliveries:
Have you experienced any of the following pregnancy complications? (Select all that apply.)
Are you currently breastfeeding?

4.Health History

Do you currently smoke or use nicotine products?
Do you currently use marijuana?
Do you currently use recreational drugs?
Are you currently taking any prescription medications?
Do you have any chronic medical conditions?
Have you had any major surgeries?

5.Lifestyle

Are you currently employed?
Are you willing to travel for medical appointments if needed?
Are you comfortable with fertility medications and injections?
Do you have the support of your spouse, partner, or family?

6.Background & Household

What is your current relationship status?
Are you currently receiving any government assistance benefits?
If yes, which program(s)? (Select all that apply.)
Have you ever been convicted of a felony?
Has your spouse or partner ever been convicted of a felony?
Are you willing to complete a criminal background check if selected to move forward?

7.Previous Surrogacy Experience

Have you been a surrogate before?

8.Tell Us About You

9.Consent

By sending this form you agree to our Privacy Policy and Terms of Use. Your answers are kept confidential.