EMERGENCY CONTACT DETAILS
YOUR FAMILY AND LIVING SITUATION
Please give details of your employment history for the last 10 years (surrogate and spouse/partner)
YOUR HEALTH AND MEDICAL HISTORY
To increase the chances of a positive pregnancy, it is usual industry practice to plant two embryos into your uterus. Bearing this in mind, please answer the following questions.
In some circumstances, a physician might recommend a fetal reduction in multiple embryos in order to protect the health of a surrogate and the baby. A physician may also recommend termination of the pregnancy due to any genetic abnormality. A
termination will never be performed due to the gender of a baby.
In some circumstances an Amniocentesis test is required during the pregnancy to diagnose any chromosomal abnormalities and/or fetal infections. A small amount of the amniotic fluid is removed from the amniotic sac and examined.
YOUR PREGNANCY HISTORY
WHAT HAPPENS NEXT?
Once you have completed this form (please check you have answered the ALL questions), upload an up-to-date photograph of yourself and email to email@example.com