HOUSTON OFFICE
  • 2950 North Loop West
    Suite 500
    Houston, TX 77092
  • 713.952.4772
  • Mon – Thur  |  8:00 AM – 5:00 PM (CST)

  • Friday  |  8:00 AM – 4:00 PM (CST)

SOCIAL

Surrogate Application

ONCE THIS FORM HAS BEEN SUBMITTED, YOU WILL BE CONTACTED WITHIN 24 HOURS (MONDAY-FRIDAY)

ALL FIELDS REQUIRED

Although you don’t need it to submit your application, in order to complete your file, you will need:

  • A valid driver’s license

  • A pap smear from within the past year

  • Verification of education beyond high school (diploma or transcripts)

  • Medical records from all of your pregnancies

  • Copy of your insurance information, including coverage, exclusions, and limitations (if applicable)

  • Copy of your marriage license (if applicable)

  • Copy of your divorces decree (if applicable)

  • Pictures of you and your family

  • Signed and notarized informed consent

A background check will be run on all applicants so please be honest as possible. We look forward to receiving your information. Please begin to get these items together.

Once we have received your application, one of our counselors will call you to schedule a phone interview.

Step 1 of 27

The following information will NOT be shared with the couple