Become a Surrogate | Apply Today

Becoming a gestational surrogate is an extraordinary opportunity to help someone achieve their dream of parenthood. At Surrogacy Heart, we connect compassionate women with intended parents seeking to build their families. If you’re considering becoming a surrogate mother, we invite you to complete our application and take the first step toward making a lasting difference in someone’s life.

Step 1 of 3

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Public Display Name

Surrogate Status

Step 1 of 3: Quick Prescreen

This helps us learn a little more about you before moving to the next step.

First Name(Required)

Last Name(Required)

Your Location(Required)

USA or US Territory

Canada

Mexico

International

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

State or US Territory(Required)

Age(Required)

Education(Required)

Less than High School

High School / GED

Trade / Vocational Certification

Some College (no degree)

Associate Degree (AA/AS)

Bachelor’s Degree (BA/BS)

Master’s Degree (MA/MS/MBA)

Doctorate / Professional Degree (PhD/MD/JD/etc.)

Prefer not to say

Education details (optional)

What is your current US citizenship status?(Required)

Have you been pregnant before?(Required)

Yes

Number of Prior Pregnancies(Required)

Number of Live Births(Required)

Occupation(Required)

Occupation of Partner (optional)

if no partner, please leave blank

Do you currently have health insurance?(Required)

Answering this question helps us understand coverage options. Having insurance is not required to apply.

Yes

If Yes to Health Insurance, please explain.

Marital Status(Required)

Single

Married

Committed Relationship (Not Married)

Divorced

Separated

Widowed

Step 2 of 3: Eligibility & Lifestyle

All answers are confidential and will be verified as part of the medical and background screening process. This ensures your safety and the success of the surrogacy journey for everyone involved.

Height(Required)

Weight(Required)

Eye Color(Required)

Hair Color(Required)

Date of Birth(Required)

Our typical surrogate age range is 21–35. If you're slightly outside this range, feel free to apply as we review every application personally.

Race/Ethnicity

(please select all that apply)

African American

Asian

Caucasian

East Indian

Hispanic & Latin

Middle Eastern

Did you have a healthy reproductive history during your previous pregnancies and births?(Required)

Yes

Please explain.

Has it been least 6 months since your last birth?(Required)

Yes

Have you taken medication(s) for anxiety and/or depression within the last 12 months?(Required)

Yes

Please explain.

Are you currently taking these anxiety and/or depression medications?(Required)

Yes

Not Applicable

Have you had any C-sections?(Required)

Yes

If Yes to C-Sections, how many?

Do you smoke or use nicotine products?(Required)

Yes

How often do you use tobacco products of any kind (including vapor, e-cigs)?(Required)

When is the last time you have used recreational drugs, such as heroin, cocaine, barbituates, etc.?(Required)

Please check any of the following that pertain to you:(Required)

Previous Arrests

Previous Convictions

Current Legal Cases

Public Housing

Restraining Order to Protect You

Divorce

Legal Separation

Social Security Income

Public Assistance

Medicaid

None of these Apply to Me

Do you have a criminal record?(Required)

Yes

If yes, please explain.

Are you willing to undergo a background check?(Required)

Yes

Are you currently raising a child?(Required)

Yes

If yes, number of children you are raising.(Required)

Have you been vaccinated for Hepatitis B?(Required)

Yes

If no, would you be willing to be vaccinated?

Yes

In the past year, have you had any tattoos and/or body piercings?(Required)

Yes

If yes, please explain.

Have you ever been a surrogate before?(Required)

Yes

Why are you interested in becoming a surrogate?(Required)

What type of intended parents are you comfortable working with?

Traditional Couple (man & woman)

Gay Couple (2 men)

Lesbian Couple (2 women)

Single Heterosexual Male

Single Homosexual Male

Single Heterosexual Female

Single Lesbian Female

Transgender Couples

I will work with all

When is the best time to contact you? (Select all that apply)

Weekdays: 8 AM–11 AM

Weekdays: 11 AM–2 PM

Weekdays: 2 PM–5 PM

Weekdays: 5 PM–8 PM

Weekends: 8 AM–11 AM

Weekends: 11 AM–2 PM

Weekends: 2 PM–5 PM

Weekends: 5 PM–8 PM

Your Time Zone(Required)

Would you prefer to be contacted by an English-speaking or Spanish-speaking coordinator?(Required)

English-speaking

Spanish-speaking

How did you hear about us?(Required)

Google

ChatGPT

Google Gemini

Claude

Perplexity

Microsoft Copilot

Other AI Assistant

Bing

Other Search Engine

Craigslist

Facebook

Instagram

TikTok

YouTube

Other Social Media

Surrogacy Heart Website

Surrogacy Heart Blog

Surrogacy Heart Care Team Member

Personal or Professional Referral

Fertility Clinic/Doctor

Conference/Event

Print/Advertisement

Other

Please Upload Your Photos

Headshot(Required)

Drag & drop or click “Browse” to select your headshot photos. Please attach at least one recent, clear photos to help us get to know you: Face clearly visible, no sunglasses or photo filters. Formats accepted: JPG, JPEG, PNG Max size: 10 MB each

Drop files here or

Max. file size: 35 MB.

Full-Body Photo (Optional)

Comfortable, everyday clothing. No need for professional photos. You can select files individually or drag several photos into the upload box.

Drop files here or

Max. file size: 35 MB.

Additional Photos (Optional)

Any other photos you’d like to share with Intended Parents (lifestyle, hobbies, family, etc.). You can select files individually or drag several photos into the upload box.

Drop files here or

Max. file size: 35 MB.

Step 3 of 3: Create Your Account

Creating an account lets you save your application, receive updates, and securely continue your surrogacy journey with us.

Email(Required)

Password(Required)

Enter Password Confirm Password

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