IParent Screening Questionnaire - True Match Surrogacy Canada

Intended Parent Screening Questionnaire

Please complete the following information as accurately as possible. All information is confidential and used solely to support your surrogacy journey.

State / Province / Territory

CORRESPONDANCE

Some description about this section

Can we leave messages related to surrogacy on your voicemail?

Yes

Can we send you mail labeled with surrogacy-related return addresses?

Yes

BACKGROUND

Questions about your personal background

Length of Relationship (Number of Years)

Are you religious?

Yes

Are you willing to submit a criminal background check?

Yes

Do you have children?

Yes

If yes, please list name, age, gender

FERTILITY and MEDICAL HISTORY

Reason(s) for pursuing surrogacy:

How long have you been trying to conceive?

What procedures or treatments have you undergone?

Are you a patient of an IVF clinic?

Yes

If yes, enter the name and location of the clinic.

Have embryos been genetically tested (PGS/PGT)?

Yes

Do you have a lawyer specializing in third party reproduction?

Yes

If yes, enter the full name of the lawyer

Have you applied to another agency?

Yes

If yes, list the name(s) of the agency

SURROGACY PREFERENCES & EXPECTATIONS

What qualities are most important to you in a surrogate?

Please describe the level of involvement you would like before, during and after pregnancy.

List any lifestyle preferences or restrictions your surrogate should follow

Would you request that your surrogate provide breastmilk?

Yes

If your child asks to meet your surrogate in the future, how would you feel?

Do you plan to be open with your child about their birth through surrogacy?

Yes

Maybe

Are you financially prepared for the surrogacy process and have you reviewed our information on surrogacy costs found on our blog?

Yes

By choosing to submit this questionnaire, I understand that True Match Surrogacy Ltd cannot guarantee a match with a surrogate and only provides introductions, guidance, support and referrals throughout the process.

I consent to have this website store my submitted information so they can respond to my inquiry

I have read and agree to the Terms and Conditions and Privacy Policy

Can you spare a few minutes to do a quick survey? Your feedback will help us improve this website.

Yes

Which best describes you?

Intended parent

Potential surrogate

Egg / embryo donor

Fertility, legal, medical, or counselling professional

Friend or family member

Researching surrogacy

Other

What brought you to our website today?

I am looking for a surrogate

I am curious about becoming a surrogate

I want to understand Canadian surrogacy laws

I want to review fees and costs

I want to book a free consultation

I am comparing agencies

I followed a social media, Google, or referral link

Other

How did you find us?

Search engine (Google, Bing, or Yahoo)

Google Reviews

Google Maps

Google Business Profile

Trust Pilot Company Profile

Better Business Bureau

Chamber of Commerce

Facebook post

Instagram post

Advertising (Google)

Advertising (Reddit)

Advertising (Facebook)

Referral from friend or family

Referral from fertility clinic

Referral from lawyer or professional

Eventbrite webinar

Community Group (Reddit)

Community Group (Facebook)

News article or blog

Other

Were you able to find what you were looking for?

Yes

Somewhat

I was just browsing

What information was most helpful?

What information was missing, unclear, or difficult to find?

The website feels professional and trustworthy.

The information is clear and easy to understand.

The surrogacy process is explained well.

Fees and payment information are easy to find.

The website feels respectful and compassionate.

I felt encouraged to take the next step.

What almost stopped you from contacting us?

Cost

Trust or credibility concerns

Legal uncertainty

Privacy concerns

Not enough information

I am not ready yet

I could not find the right form or next step

Nothing

Other

What action are you most likely to take next?

Book a free consultation

Complete an intended parent questionnaire

Complete a surrogate screening questionnaire

Contact another agency first

Not sure yet

How likely are you to recommend our website to someone else? (0 = unlikely, 10 = absolutely)

Do you have any final comments or suggestions?

May we follow up with you?

Yes

Age Group (Years)

Under 18

18 - 30

31 - 40

41 - 50

51 - 60

Over 60

Country of Residence

Intended Parent Screening Questionnaire

Intended Parent #1

Intended Parent #2

CORRESPONDANCE

BACKGROUND

FERTILITY and MEDICAL HISTORY

SURROGACY PREFERENCES & EXPECTATIONS

FINANCIAL READINESS