Complete this application to begin your surrogacy journey with EMS
Step 1 of 11
These are the Basic Surrogate Qualification Requirements to be approved to become a Surrogate - You need to be able to Check the box next to all 7 of the questions below - Before Starting Your Profile With Us. *
Contact Information *
What is the best time and way for a Surrogate Coordinator to contact you as needed for approval. Please choose all that apply.
Do you have any specific questions that you would like answered right away?
Please feel free to ask anything and everything. It can be a confusing process and we are here to help whenever questions arise.
Do you have a valid Drivers License or Government Issued ID for Travel related purposes? *
Do you own or have access to a car in order to attend appointments?
If you do not have transportation or a valid License what form of transportation will you use to attend medical appointments?
Current Age
Date of Birth *
What is your height? *
What is your current weight? *
When did you last see your OB/GYN?
When was your last pap smear?
What were the results of your last pap smear?
When was the first day of your last period?
What is your blood type?
Have you been Diagnosed or Treated for a Mental Health Condition? *
If you previously experienced any Mental Health Condition please list the general dates of your condition (as well as any medications if applicable)
Please describe your diet in general (i.e. if you are a vegetarian/vegan, what type of food do you eat regularly?
Do you exercise?
If Yes please list activities and how often.
Have you ever been hospitalized or had surgery aside from Childbirth?
If Yes, please list reasons and year of incidents.
Do you have any chronic medical conditions/problems? *
If Yes, please specify.
Have you or anyone in your home smoked any form of tobacco, marijuana or and form Vape/E-cigarettes? *
Do you drink alcohol?
Do you use any recreational drugs? *
Have you or a sexual partner been diagnosed with a sexually transmitted disease in the last 6 months? *
If yes- (please specify) treatment and dates
Are you currently employed? *
What is your current occupation/position?
On average how many hours do you work per week?
What days of the week do you work?
What is your hourly wage or salary per week?
Does your employer provide short term disability?
Current Legal Marital Status *
If married, what is the date of your marriage?
Date of Divorce Finalization
If unmarried but in a committed relationship how long have you been together?
Does your Partner financially contribute toward your living expenses?
Does spouse/partner drive?
Spouse/partner's current occupation/position
What days of the week does spouse/partner work, and what are the hours?
Spouse/Partner's average income either hourly or monthly.
What is your custody arrangement with the other parent of your child(ren)? *
Have you and your partner experienced domestic violence in your home together?
Been convicted of a felony? *
If Yes please explain
Been charged with child abuse or neglect? *
If Yes, please explain
As an adult have you suffered from substance abuse or completed a Substance Abuse program? *
Been arrested as an adult? *
If yes please explain reason. Use dates, outcome and current status.
Have you had the Department of Children and Family Services investigate regarding your children's welfare while in your home? *
If Yes, please explain, dates and outcome.
Are you enrolled for 2026 Health Insurance? *
Name of Health Insurance Company
Where did you obtain your Health Insurance Policy from?
What is your yearly deductible?
(If you don't know leave blank)
What is your coverage percentage?
What is your co-payment?
($/per office visit) (If you don't know leave blank)
What is your maximum out-of-pocket expense per year?
How many times have you given birth? *
Please list Gestational Week, Date of birth, and Birth weight for each delivery. *
How many C-Sections have you had? *
How many miscarriages have you had? *
If you have previously experienced a miscarriage please list the: year, gestational weeks, and if D&C was required for each
Have you completed a Surrogacy previously?
If you have previously been a Surrogate what was the outcome of those experiences?
Have you ever placed a child for adoption? *
If Yes please specify number of times and years.
Are you currently breast feeding? *
If Yes- when is your expected timeline to wean?
Have you had any serious pregnancy or delivery complications? *
"Serious" would require medical intervention. (medically treated pre-term labor, Pre-Eclampsia, Gestational Diabetes)
Do you have regular menstrual cycles?
How are you currently preventing pregnancy at this time? *
i.e. BC pills, Condoms, Implant, IUD, Depo, Abstinence, Tubal Ligation, Vasectomy If using a long term hormonal form such as an IUD, Depo shot or implant please list when you started or had your most recent dose. If you or your partner has had surgical sterilization please list.
How far is the closest hospital to you?
If unknown leave blank and a Coordinator will research for you.
What is the name of the closest hospital to you?
How far is the closest hospital with a Level 3 NICU?
What is the name of the closest hospital with a Level 3 NICU?
Have you discussed your plans to become a Surrogate with your spouse or partner if applicable? *
If Yes, what was their reply?
Who will support you emotionally throughout and after your Surrogacy experience?
You will be given one of the Agencies amazing Coordinators for everything from scheduling to texting about how you're feeling. They are all former Surrogates themselves so they understand what it's like to be in your shoes. We also recommend everyone has a good friend or family member in their day to day life to cheer them on.
For a transfer, I am open to travel: All travel related expenses are covered by the Intended Parents.
What languages do you speak?
We have Intended Parents from multiple countries and while most speak English it can be extra special to share your journey together in their home language also.
Please select all Intended Parent scenarios that you are happy to help
What drives you to want to be a Gestational Surrogate?
(Please explain in as much detail as possible.) This helps explain to hopeful parents that have to trust the life of their child with someone that starts off as a stranger her motivations for having the heart to help them. To many Intended Parents it's nearly unbelievable someone could be so generous.
Please tell us about yourself! Describe your personality, character, interests, and hobbies. Are you soccer mom driving your kids from one thing to the next and loving every minute of it?
Are you a nurse and have a passion for helping people, do you love animals or hiking? Maybe the beach on a tropical island and book in your hands is more your speed? This is about you and what drives you to be you. Giving a glance at what makes you you helps make connections.
How much contact would you like with your Intended Parents throughout the pregnancy?
This helps set expectations from the start. Are they welcome to ask for videos of the baby kicking or are you more private and would prefer someone who is also more reserved?
Are you willing to sign a HIPAA release form for the Intended Parents and Agency to be allowed to receive medical information pertaining to the baby (ies)?
This is a standard Legal Contract requirement so that the Parents always feel like nothing medically related to the baby could be withheld from them. We like to make certain each applicant is okay with this prior to matching.
How would you feel about the Intended parents joining you at these doctor appointments, and potentially being present in the doctor's office during ultrasounds?
Many of our Parents are International but even a number of them enjoy coming over for some appointments or arriving weeks prior to birth and getting to be more involved.
Would you be comfortable with the Intended Parent(s) being in the delivery room when their baby(ies) is/are born?
At times the IVF doctor will allow transferring 2 embryos to increase the likelihood that a pregnancy will occur. This can be due to the quality of the embryos, the age of the eggs used to create the embryos or due to Intended Parents requests. Because of this, it is possible that you could become pregnant with multiples. How would you feel about carrying twins?
In an extremely rare case if it is confirmed that you are carrying triplets or more, and the Doctors recommend reducing to increase the chances of protecting your longterm health and the surviving babies would you be willing to accommodate the Intended Parents' wishes to do so based on medical recommendations?
This would solely be requested based on sound medical advice from your doctor and second opinions are also welcomed.
If it is confirmed that the baby has a SERIOUS uncorrectable health condition and the doctors approve termination due to either the baby not being able to survive outside of the womb or the condition would leave the baby with lifelong SERIOUS health issues; would you be willing to accommodate the Intended Parents' wishes and terminate the pregnancy based on medical recommendations?
Intended Parents come to Surrogacy often times after many losses or situations in which a natural occurring pregnancy could never be hoped for. They spend their lives savings on medical doctors in order to make their precious embryos just to have hope of healing their own hearts and fulfilling a natural human need to have children of their own so please know that this would never be asked for something correctable or minor. If they would not want to terminate the pregnancy they'd still like the right to make the parental decisions for their child the same as any parent would want the right. No terminations would be allowed due to any reason outside of serious non-correctable health issues for the baby or your health.
Do you have any out of State or Country Travel plans (work trips, vacations, weddings, etc.) that you anticipate or have scheduled that will occur within the next 12 months?
If "Yes" please list dates and locations
How would you feel about getting the COVID-19 vaccine? *
Base Compensation
Base compensation does not include any expenses incurred by you. It is solely for your time and efforts required. Suggested requested base fee is $35,000 - $60,000 depending on location and previous experience. If you would like more advice on averages for your area please leave blank and a Coordinator can assist you.
Transfer Fee or Canceled Cycle Fee if no Fault of Surrogate: Average request is $500
Monthly Expense Allowance
Average request is non-accountable $200 from the start of Contract signing.
Maternity Clothing Allowance
Average request is $400 Singleton/$700 Twins
Life Insurance
Average request is Direct Cost of $250,000 Policy paid to the Beneficiary of your choice.
C-section Fee
Average request is $2,500
Multiple Fetus Fee
Average request is $5,000 per additional fetus after 16 weeks.
Lost Wages for doctor ordered bedrest
Average request is Direct Expenses
Loss of Reproductive Organs
Average request is $5,000
Termination/Selective Reduction
Average request is $1,500
Invasive Procedures
Average request is $500 per incident.
How did you first hear about Expect Miracles Surrogacy?
Your photos *
Add at least one clear photo of yourself (up to 6; JPG, PNG or WebP, 5 MB each). Your first photo is used on your profile and stories once approved. Photos are private until staff publish your profile.
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