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GESTATIONAL CARRIER PRE-SCREENING APPLICATION

At Gestational Concepts©, we admire individuals whose wishes are to give a wonderful gift of life to intended parents.  We follow a strict guideline leading to the acceptance of only highly qualified gestational carriers. To see if you pre-qualify, please fill out the SECURE "Gestational Carrier Pre-Screening Form" below.

Are you currently between the ages of 21 and 43?
Have you ever had a miscarriage?
Have you had at least one successful and healthy birth (no complications) with a child that currently lives with you?
Did you receive fertility treatment in order to get pregnant?
Do you have a valid drivers license and reliable transportation?
What is your body mass index (BMI)?
Have you ever been convicted of a felony?
Do you have a history of drug or alcohol abuse?
Have you ever taken anti-depressant medication?
Do you currently smoke?
Are you currently employed?
Do you currently have medical insurance?
Are you on government assisted living?
Have you ever been a gestational carrier?
Are currently a U.S. citizen?
Does your family support your decision in becoming a gestational carrier?

Why do you want to become a gestational carrier?

How did you hear about us?

Thank you !

A Gestational Concepts representative will contact you soon with your pre-application status.

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