SURROGATE MOTHER QUESTIONNAIRE - Generix medical
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SURROGATE MOTHER QUESTIONNAIRE

To become a surrogate mother, please fill out this short questionnaire — it is your first step toward participating in the program. We will contact you shortly to clarify the details and answer all your questions.

You do not need to take any medical tests beforehand — we will provide all necessary examinations at our own expense.

175
140 cm 195 cm
70
45 kg 100 kg
30
18 years 40 years

Your Blood Type

Your Rh Factor

Your Marital Status

Do you have children of your own?

Have you ever had a cesarean section?

How do you prefer to be contacted?

Consent to the processing of personal data

Your information will be kept strictly confidential and used exclusively for medical purposes.