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Surrogate Prescreening Survey

This application helps Circle Surrogacy pre-screen candidates. Please take the time to ensure complete and correct responses. If you have any questions as you complete the application, give us a call at 617-439-9900!

Can't finish the survey in one sitting? Not to worry! As long as you use the same computer, we'll save your progress every step of the way, so you can come back later to finish up.

  • 1. Email address
  • 2. Date of Birth

  • 3. Have you used tobacco within the last year?
  • 4. Is your BMI over 33? (You can check your BMI at The CDC Website)

  • 5. Do you have any history of illegal drug use or alcohol abuse?
  • 6. Are you currently pregnant?

  • 7. Have you given birth before?

  • 8. Have you ever had a C-Section? If so, how many have you had?
  • 9. Have you achieved at least a high school diploma or GED?

  • 10. Are you currently receiving any government financial assistance? (this would include public housing, welfare subsidies but not Medicaid)