Pennsylvania Surrogacy Lawyer - Gestational Carrier and Surrogate Parenting Attorney

Gestational Carrier & Surrogate Questionnaire

If you are interested in being a gestational carrier or traditional surrogate and you are in good health, are over twenty years of age, live in Pennsylvania or a nearby state (other than New York) and have previously given birth to at least one child, please call Mr. Kalikow at (215) 682-9100, e-mail him at info@pasurrogacy.com. or call 1-800-808-5454.

Mr. Kalikow represents intended parents who are waiting to find the right person to carry their child. To expedite matters, you may wish to complete and return via e-mail the preliminary questionnaire below.

Please note, the information that you provide will be made available to Mr. Kalikow's clients.

No attorney/client relationship is established by filling out this questionnaire.

Your Name:

Telephone:

Email Address:

State and County of Residence:

Age:

How many biological children do you have?

Marital status?

When did you last give birth to a child?

Do you smoke or use tobacco?

Do you currently have health insurance? If so, does it include coverage for prenatal care and delivery?

Are you presently employed? If so, how are you employed?

Are you interested in being a gestational carrier (in which you would not be genetically related to the child), or a traditional surrogate (in which you would be a genetic parent of the child)?

Thank you for filling out this questionnaire. Your interest in being a gestational carrier and/or a surrogate mother is sincerely appreciated.

LEGAL DISCLAIMER:The information provided at this web site is advertising material and is for general information purposes only. The material on this site does not constitute legal advice. DO NOT act upon this information without first consulting an attorney. No Attorney-Client relationship is formed unless agreed to in writing.

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