How to Become a Surrogate Please complete our Surrogate Inquiry Form below so we can contact you and discuss our program further. Full name*Email* Phone*Date of Birth* Date Format: MM slash DD slash YYYY Height*Weight*Marital Status*Marital StatusSingleDomestic PartnerMarriedDo you have any children?*Do you have any children?YesNoHave you been a surrogate before?*Have you been a surrogate before?YesNoDo you have health insurance?*Do you have health insurance?YesNoHow did you hear about us?*How did you hear about us?Word of MouthInternet SearchPrint AdvertisementCraiglistHawaii JobsOtherAdditional CommentsCAPTCHACommentsThis field is for validation purposes and should be left unchanged.