Form
Intended Parent(s) Application
Tiny Treasures Advocacy
Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
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Month
-
Day
Year
Date
Age
Occupation
Relationship Status
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Partner's Name
First Name
Last Name
Partner's Email
example@example.com
Partner's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Partner's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Partner's Date of Birth
-
Month
-
Day
Year
Date
Age
Occupation
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How soon are you hoping to start your surrogacy journey?
Were you referred to our agency? How did you hear about us?
Check all that apply to your surrogacy thus far
IVF clinic hired
Embryos created
Embryos genetically tested
Escrow company decided (We always recommend SeedTrust as the escrow holder)
Attorney decided (We have a list of reputable attorneys to provide to you as well)
What IVF clinic are you using?
Who is your IVF doctor?
Do you have embryos?
Yes
No
How many embryos do you have?
Are your embryos genetically tested? If so, are any of them considered mosaic?
Are your embryos created with donor eggs or donor sperm? If so please specify.
Is covid vaccination a requirement for your surrogate? Does your clinic require the covid vaccination?
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Please tell us a bit about yourself (and your partner if applicable). Interests, hobbies, and things you enjoy doing
Where are you from? Where is your partner from (if applicable)
Do you currently have children? If so please list their ages.
Please describe why you are looking for a gestational carrier.
Please describe some of the highs and lows of your fertility journey this far.
Are you open to matching with a surrogate in ANY surrogacy friendly state? If not please list the states you are open to.
Do you want to attend doctor appointments? If you are not local would you like your surrogate to video chat you during appointments if the medical office allows?
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What type of relationship do you want to have with your surrogate during and after the journey?
Are you wanting to do a single or double embryo transfer?
Are you open to selective reduction if doctor recommended?
Do you want to be present (in the room) at birth. (If c-section is required this may not be feasible)
Please upload a minimum of 5 pictures for your potential surrogate to see.
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