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Thanks for your interest in becoming a surrogate with Circle. We need a little more information about you at this point. This questionnaire should take about 10 minutes to complete. If you're unable to complete it in one sitting, no problem -- we will save your progress and you can return to it later. Please know that we keep all of your information confidential.

  • 1. Full Name

  • 2. If you have a partner or spouse, what is his/her name?

  • 3. Please list dates of all marriages and, if applicable, the dates of all divorces that were finalized in court. (Write "none" if you have never been married.)

  • 4. Are you religiously affiliated?

  • 5. If you have a partner or spouse, is he/she a member of the U.S. military?

  • 6. Have you ever had a psychiatric hospitalization? If yes, when, where, and for how long?

  • 7. Are you financially stable?

  • 8. What is your occupation?

  • 9. Do you work in a state that is different from your state of residence?

  • 10. If you have a partner or spouse, what is his/her occupation?