Surrogate Questionnaire | Les Petits Surrogacy

What would your family do with an extra 💰$65,000 to $115,000💰?*

💵Pay off debt so fast your credit score sends a thank-you card

🏫Fund college, braces, camps or sports – whatever your kids need to succeed

💭Invest in your dreams: Get a degree 📚, travel, buy a house, retire, invest, start a new business

🌴Trade financial stress for family memories … and maybe matching vacation hoodies

🐣Just helping another family bring home their baby is reward enough, but building a nest egg would be nice too!

First things first — how many babies have you delivered?*

👣 I’m a proud mama of one

👣 Two

👣 Three or more

👣 None yet, but I’m curious about surrogacy

How old are you?*

😊19-25

🧑‍🦱26-32

🧔33-42

🧔43+

Are you a U.S. resident?*

✅U.S. citizen

✅U.S. permanent resident

✅Other citizenship status

How would you describe your pregnancies?*

⛵ Smooth sailing

🌈 Mostly easy with minor bumps

💪 Challenging, but manageable

🩺 I experienced complications

🕰️Haven’t had a baby yet, so time will tell!

Have you ever been a surrogate before?*

🌟 Yes — and I loved it

🌟 Yes — but I have questions before doing it again

🌟 No, this would be my first surrogacy journey

How supportive is your household of you exploring surrogacy?*

❤️❤️❤️ Fully supportive

❤️❤️ Mostly supportive

❤️ Still discussing it

🩶 Prefer not to say

What matters most to you in your surrogacy journey?*

(Be honest — there’s no wrong answer here 💛)

✨ Building a real, lasting connection with the intended parents

✨ Feeling supported, heard and taken care of every step of the way

✨ A smooth, well-guided journey with clear communication (less stress, more peace)

✨ Making a life-changing difference for a family who needs me

✨ A little bit of everything – because this journey is kind of a big deal

Are you ready to get going?

✅Yes! Send me the application.

📱Not yet. I have some questions. Please contact me:

🤔No, I’m still thinking about it.

👎No. I don’t think this is for me.

What is your first name?*

How do you want us to reach you? (email/phone)*

Email*

Phone*

No problem, we understand! We are here if you need us. Would like for us to follow up with you in 72 hours to see if you have any questions?*

Yes

No, I will contact you when I’m ready.

What is your first name?*

How do you want us to reach you? (email/phone)*

Email*

Phone*

No problem. We understand. We will email you to let you know if you qualify and provide you with Rebecca Gallego's contact information so you can reach out to her if you ever have any questions.

Thank you for visiting our website. Here is a story about a successful surrogacy journey if you want to learn more.

Email*