03 (Original) Intented Parent(s) Template

Intended Parent(s) Match Questionnaire
Are you the Intended Parent or Intended Parents? *

Intended Parent; I'm entering surrogacy by myself Intended Parents; the two of us are entering surrogacy together

Personal Contact Information
All your personal contact and confidential information is for Love & Kindness' internal use only. We would only share your (preferred) first name, nation/city origin, gender and age with surrogate candidates.

If you’re an agent/representative filling this section out on behalf of intended parent(s), please be sure to NOT input your own contact information. Please input the intended parent(s)' actual email, address, and phone number as it is very important for us to have this information, especially for emergency situations.
Intended Parent 1
Full Legal Name *

First Name Middle Name Last Name
Preferred First Name (if any)
Birth Date *

Month Day Year
Gender *

Male Female
List all the countries you hold citizenship or permanent residency of: *
Email *

Confirmation Email
Residential Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Country Code Area Code Phone Number
Upload a copy of government ID

Browse Files
It is okay if you don't feel comfortable providing it at this time; we will collect it from you during the legal phase. Cancel of

Intended Parent 2
Full Legal Name *

First Name Middle Name Last Name
Preferred First Name (if any)
Birth Date *

Month Day Year
Gender *

Male Female
List all the countries you hold citizenship or permanent residency of: *
Email (if different from above)

Confirmation Email
Residential Address (if different from above)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number (if different from above)

Country Code Area Code Phone Number
Upload a copy of government ID

Browse Files
It is okay if you don't feel comfortable providing it at this time; we will collect it from you during the legal phase. Cancel of

Personality Profile
First Name *
Gender *

Male Female
Age *
E.g., 39.
City, State or Country *
E.g., Toronto, Canada.
Intended Parent 1 First Name *
Gender *

Male Female
Age *
E.g., 39.
City, State or Country *
E.g., Toronto, Canada.
Intended Parent 2 First Name *
Gender *

Male Female
Age *
E.g., 39.
City, State or Country *
E.g., Toronto, Canada.
Upload five (5) to ten (10) photos of yourself/yourselves and your children (if applicable)

Browse Files

Cancel of

Surrogate candidates always enjoy learning about their prospective intended parents. It would help the candidate get to know you and better the matching process. Please kindly introduce yourself/yourselves and your family. *

You can share your life story, your career, what's been going on with your life, etc. Anything at all. As brief or as detailed as you would like. 0/200
Please briefly explain your motives for pursuing surrogacy. *

If there is anything you’d like to say to the candidate, you can also type that here. 0/200
Please briefly explain how many embryos you would like to transfer. *
How many children would you like your surrogate to carry? *