Dream Big!It’s okay we are here to help. We work nonstop to find you exactly what you need…Our team painstakingly find the absolute best surrogates available. That are screen and test to ensure that these are the top candidates available. We are there every step of the way. So intended parents need additional help possibly to find a great egg or sperm donor. We are there to make sure whatever your needs are you receive the absolute best care available.We have one purpose that is to do everything in our power to help you reach your dreams of having a baby. Contact Intended Parent Intended Parent #1 Name 准父母 1 名字 Name 名字 * First Name Last Name Email 邮箱地址 * Phone 电话 * Country (###) ### #### Age 年龄 * Address 地址信息 * Address 1 Address 2 City State/Province Zip/Postal Code Country Intended Parent #2 Name 准父母 2 名字 Name 名字 First Name Last Name Email 邮箱地址 Phone 电话 (###) ### #### Age 年龄 Preferred Contact 常用联系方式 * Intended Parent #1 准父母 1 Intended Parent #2 准父母 2 Which services are you interested in? 请选择以下服务项目 * Surrogacy 代孕 Egg Donor 捐卵 Concierge Fertility 体外注射受精 Sperm Donor 捐精 Unsure 未确定 Are you working with a clinic? 您有正在合作的诊所吗? * Yes 有 No 没有 Comments or Questions 基本信息 Do you need an interpreter? 你在流程中需要用到翻译吗? * Yes 需要 No 不需要 Preferred Language 你倾向使用的语种: How did you hear about us? 您是怎么知道我们机构的? * Google 谷歌 Print Ad 广告 Doctor or Clinic 医生/诊所 Friend or Family 朋友/家人 Facebook 脸书 Other 其他 Tell us about yourself, what do you do, what are your hobbies, your interests? 请您介绍一下自己,您的职业,您的兴趣爱好? Tell us about your partner, what do they do, what are their hobbies, their interests? 请您介绍一下您的伴侣,伴侣的职业,兴趣爱好? How did you learn about surrogacy? 您是怎么知道代孕服务的? How do you believe surrogacy works? 您对代孕的了解程度? Why have you chosen surrogacy? 您为什么选择代孕服务? What clinic are you working with? 您现在所在诊所的名字? How many attempts are you comfortable with? 您倾向移植的次数? How many embryo's do you anticipate transferring? 您倾向移植胚胎的个数? How will the ovum be provided?试管周期卵子的来源 Intended Mother 自卵 Known Donor 已知捐卵人 Egg Donor 匿名捐卵人 Other/Unknown 其他/未知 How will the sperm be provided? 试管周期精子来源 Intended Father 自精 (丈夫) Intended Father(s) 自精(夫夫) Known Donor 已知捐精人 Sperm Donor 未知捐精人 Other/Unknown 其他/未知 Do you plan on doing PGD? 您有做 PGD 的打算吗? * Yes 有 No 没有 Do you plan on doing gender selection through PGD?您有做 PGD 选择性别的打算吗? * Yes 有 No 没有 Do you plan to do an amnio or CVS? 您有做羊水穿刺的打算吗? * Yes 有 No 没有 If your child were to have serious birth defects would you chose to terminate the pregnancy? 如果在孕期宝宝检查出有严重的先天缺陷,您会选择终止妊娠吗? Yes 会 No 不会 Unsure 不确定 Are you willing to work with a surrogate who is not comfortable terminating for downs syndrome? 如果孕妈妈不倾向于在宝宝有先天缺陷的情况下终止妊娠,您会选择于她合作吗? * Yes 会 No 不会 Are there any circumstances you would not consider terminating under? 您会在某些特定的情况下选择不终止妊娠吗 What are your feelings on multiples? 您多双胎或多胎会有什么异议吗? * Yes 会 No 不会 Not sure 不确定 Please describe your support system 您的家人朋友对您代孕的帮助与支持 Do you have any concerns over how others may react to your choice to use a surrogate? 您是否介意他人看待您选择代孕这种方式? How will having a baby or babies change your life? 宝宝对您的重要性? What are your hopes and dreams for your future child? 您对宝宝有什么样的期望? Describe your ideal surrogate? 您理想中的孕妈妈是什么类型的? Are there any surrogates you would not be comfortable working with? 您有没有特别不想合作的孕妈妈类型? * Yes 有 No 没有 Do you wish to attend the delivery? 您希望在生产的时候陪产吗? * Yes 是 No 不是 Do you plan to video tape or record the birth? 您有打算将生产过程拍摄下来吗? * Yes 有 No 没有 Who else would you like to have in the room? 您希望都有谁陪同您在产房? Would you like your surrogate to pump breast milk for your baby? 您需要孕妈妈产后提供母乳吗? * Yes 需要 No 不需要 Do you have any special requests of your surrogate? 您对您的孕妈妈有什么特殊的要求吗? What kind of relationship would you like to have with your surrogate? 您希望在整个孕期与孕妈妈保持什么样的联系方式? How often would you like to communicate with your surrogate during the pregnancy? 在孕期您希望多久与孕妈妈联系一次? * Daily 每天 Weekly 每周 Bi-Weekly 每两周 Monthly 每月 No Preference 没有特定的时间 How do you prefer to communicate with your surrogate during the pregnancy? 在孕期您希望与孕妈妈用什么样的方式进行交流? Email 邮件 Phone Calls 电话 Texts 短信 Mail 信件 Personal Visits 见面 Not at all 不交流 No Preference 没有特定方式 How often would you like to communicate with your surrogate after the birth? 在产后您愿意与孕妈妈保持什么样的交流方式? * Daily 每天 Weekly 每周 Bi-Weekly 每两周 Monthly 每月 No Preference 没有特定方式 How do you prefer to communicate with your surrogate after the birth? 产后您愿意与孕妈妈保持联系吗? * Email 邮件 Phone Calls 电话 Texts 短信 Mail 信件 Personal visits 见面 Not at all 不交流 No Preference 没有特定方式 What do you plan to tell your child about surrogacy if anything? 您打算跟您的孩子说关于代孕的事宜吗? What message would you like to send to your future surrogate? A short letter is a great way to tell her who you are and share your personality. 您对您未来的孕妈妈有什么想说的?您可以简短的写一段话给您的孕妈妈,分享您的经历 ,想法。 Thank you!