Click here to see if you pre-qualify. Become a Gestational Carrier!

Are you currently between the ages of 21 and 40?

YES

NO

Have you ever had a miscarriage?

YES

NO

Have you had at least one successful and healthy birth (no complications) with a child that currently lives with you?

YES

NO

Did you receive fertility treatment in order to get pregnant?

YES

NO

Do you have a valid drivers license and reliable transportation?

YES

NO

What is your body mass index (BMI)?

33 or Less

34 or More

Have you ever been convicted of a felony?

YES

NO

Do you have a history of drug or alcohol abuse?

YES

NO

Are you currently taking anti-depressant medication?

YES

NO

Do you currently smoke?

YES

NO

Have you had 3 or more C-Sections?

YES

NO

Have you had 5 or more vaginal deliveries?

YES

NO

Are you on government assisted living?

YES

NO

Have you ever been a gestational carrier?

YES

NO

Are currently a U.S. citizen?

YES

NO

Does your family support your decision in becoming a gestational carrier?

YES

NO

702-776-7746

info@gestationalconcepts.com

GESTATIONAL CARRIER PRE-SCREENING APPLICATION

How did you hear about us?