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Surrogacy Parents Survey

Part 1: Tell Us About Your Family

Session

Manual entry?

1. Parent #1

First Name

Last Name

City

State (USA or Canada)

Country *This question is required.

Email Address *This question is required.

Alternate email (optional) This question requires a valid email address.

Do you identify as:

Were you a recipient of discounts or pro bono assistance from the Gay Parenting Assistance Program (GPAP)?

Since you were part of GPAP, do you have any feedback that we may quote in order to promote the program on our website or other materials about MHB and GPAP? You may sign with your name, initials, or no name at all.

Note: your feedback will remain anonymous and personal information obtained during this research will be kept confidential to the extent permitted by law. Your answers will be used only for identifying needs, trends and satisfaction levels regarding service providers. However, a valid email is required so we can send you a confirmation email to verify that you indeed submitted this survey.

2. Did you have / are you raising your children as:

Parent #2

First name

Last name:

3. How many children do you have?

4. How many surrogacy journeys did you do all together (a journey is one or more cycles that resulted in a birth of one or more children)?

Do you intend to have more children in the future (choose the most likely answer)?

5. Professional services you used on your surrogacy journey (choose all that apply):

Surrogacy (and possibly egg donation) agency
Fertility clinic (and possibly egg donation)
Independent egg donation agency (outside your clinic or surrogacy agency)
Legal services (outside a surrogacy agency)
Escrow / fund management (outside a surrogacy agency)
Psychologist / social worker
Surrogacy consultant
Other Please enter an 'other' value for this selection.