Become a Surrogate at Harmony Surrogacy

Questionnaire

Harmony Surrogacy
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Become a Surrogate with Harmony Surrogacy

Estimated completion time:
3-5 minutes

Welcome to Harmony Surrogacy! We totally get what a huge thing it is to even consider becoming a surrogate. It says a LOT about the kind of person you are that you are thinking about it. We want you to feel safe, supported and valued through this entire process. Remember, Harmony Surrogates can set their own compensation. Realistically, most of our first-time carriers earn around $65,000, with additional benefits that can significantly increase your total compensation. These can include coverage for bed rest, lost wages, breast milk provision, maternity clothing, mock cycle and medication start fees, monthly installments, allowances, reimbursements for additional expenses, and delivery via C-section. It all adds up!

The application process consists of two phases:

1) The Prescreen Questionnaire: This is a short questionnaire that screens you on basic surrogate qualifications. Once you pass this stage of the application process, you will be prompted to complete the full questionnaire.

2) Full Questionnaire: Once you submit this short prescreen questionnaire and it is accepted, you will be prompted to complete the full-length questionnaire. The full questionnaire is a slightly more involved survey that dives into more detail on everyone's favorite topic - YOU! So to get started, sit back, relax and complete the pre-screen questionnaire below.

Super important: Before you begin, we want to make sure you have the safest and healthiest journey possible. Our medical team will carefully review all your records, so it’s essential that everything is honest and accurate. This is not the time to list a goal weight or skip over past complications. Being accurate with this information helps us give you the very best care and it saves everyone a lot of time. If you're not sure, please feel free to reach out to me before submitting your application. The last thing we want is for you to be disqualified further in the process. It's heartbreaking for everyone involved.

PS: Be sure to check “yes” to receiving texts. It’s the only way we can stay in touch about your application, and we’d hate for all your effort to go to waste. - Missy

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1. What's your First Name? *

2. What's your Last Name? *

3. What is your primary phone number? *

4. Do we have your permission to text at this number (please check "Yes" to receiving text messages so we can contact you if you're approved)? *

5. What is your date of birth? *

6. What is your height? *

7. What is your weight? *

8. Have you had at least one healthy, full term pregnancy and delivery? *

9. How many total pregnancies have you had? *

10. What State do you live in? *

11. What is your U.S. citizenship status? *

U.S. Citizen
U.S. Permanent Resident
U.S. Green Card
Other

12. Have you or your spouse/partner ever committed any crimes? *

13. Do you currently receive any forms of government assistance (please select all that may apply)? *

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