Surrogate Eligibility Quiz Surrogacy Eligibility Quiz Surrogacy Eligibility Quiz Name(Required) First Last Email(Required) Enter Email Confirm Email Phone(Required)Address(Required) ZIP / Postal Code Are you between the ages of 21 and 42 years old?(Required) Yes No Are you a U.S. citizen, a permanent resident or do you hold a visa/green card?(Required) Yes No Have you had at least one full-term, uncomplicated pregnancy and are parenting a child?(Required) Yes No Are you (and your spouse/partner, if applicable) able to pass a criminal background check?(Required) Yes No Are you in excellent health with a healthy weight/height ratio?(Required) Yes No Are you financially stable and less dependent on government aid?(Required) Yes No Do you have a high school diploma or GED?(Required) Yes No Consent(Required) I agree to the privacy policy and Terms of Service.Thank you for taking the quiz!(Required)We’ll be in touch shortly. In the meantime, please indicate your preferred form of communication email phone text Consent “Opt-in” to receive future emails from Les Petits Surrogacy & Fertility Consulting?
