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Initial Intake

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Download the following forms and use the Initial Intake Checklist to double check that you have submitted all of the documents we need to begin the surrogacy process. We know it's a lot, but we promise it is worth it! 

Surrogate Forms

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Surrogate Questionnaire

This questionnaire is to be filled out by surrogates interested in working with Little Miracles Surrogacy.

Background Check 

The background check form must be completed for each member of your home over the age of 18.

HIPAA Release Form

The Hipaa release form gives LMS the right to obtain medical information for the purposes of surrogacy.

OB Release

The Ob release allows LMS to obtain information from your Ob/Gyn in relation with your past pregnancies.

Medical Release

The medical release form allows LMS to obtain your medical records from the appropriate offices and hospitals.

Social Media Accounts - Surrogate

Surrogates, this form shares with LMS your social media accounts.

Text Message Consent

This form gives us permission to text you.

Media Release

The media release gives LMS the right to publish images or stories with you permission. Your partner (if applicable) must fill out a separate media release form.

Initial Intake

Click the cloud to download

Download the following forms and use the Initial Intake Checklist to double check that you have submitted all of the documents we need to begin the surrogacy process. We know it's a lot, but we promise it is worth it! 

Intended Parent Forms

Click the cloud icon to download each form.

Intended Parents Application

This questionnaire is to be filled out by intended parents who are interested in working with Little Miracles Surrogacy.

Background Check

The background check form must be completed for each member of your home over the age of 18.

HIPAA Release Form

The Hipaa release form gives LMS the right to obtain medical information for the purposes of surrogacy.

Credit Card Authorization

This form is to keep your information on file for use with your surrogacy journey.

Media Release

The media release gives LMS the right to publish images or stories with you permission. Your partner (if applicable) must fill out a separate media release form.

Social Media Accounts - IP

Intended Parents, this form shares with LMS your social media accounts.

Text Message Consent

This form gives us permission to text you.

Forms Available for Download 24/7 for your convenience

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