Surrogate Questionnaire

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" background="043085a3.jpg"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Georgia" ><B>Parenthood Options</B></FONT><B>    </B><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="Parenthood Options"><U><B>home</B></U></A></div> <div> <A HREF="id32.htm" TARGET="_top" TITLE="Waiting Intended Parents"><U>Waiting Intended Parents</U></A>   |   <A HREF="ivf_faqs.htm" TARGET="_top" TITLE="IVF FAQs"><U>IVF FAQs</U></A>   |   <B>Surrogate Questionnaire </B>   |   <A HREF="id23.htm" TARGET="_top" TITLE="Intended Parent Questionnaire"><U>Intended Parent Questionnaire</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFFFFF" TEXT="#080000" background="044d2e83.jpg"> <div> <A HREF="index.htm" TARGET="_top" TITLE="Parenthood Options"><U>Parenthood Options</U></A></div> <div> <A HREF="information_for_surrogates.htm" TARGET="_top" TITLE="Information for Surrogates"><U>Information for Surrogates</U></A></div> <div> <A HREF="ivf_faqs.htm" TARGET="_top" TITLE="IVF FAQs"><U>IVF FAQs</U></A></div> <div> <A HREF="id31.htm" TARGET="_top" TITLE="Links,Resources and Downloads"><U>Links,Resources and Downloads</U></A></div> <div> <A HREF="id25.htm" TARGET="_top" TITLE="Contact Us"><U>Contact Us</U></A></div> <bR> <bR> <bR> <bR> <bR> <bR> <bR> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I><B>B</B></I><I><B>asic Requirements</B></I></div> <bR> <div> <I>Parenthood Options is currently on hiatus and is not accepting new Surrogates or Intended Parents at this time. Thank you.</I></div> <div> <I>21-43</I><FONT SIZE="4" COLOR="#000000" FACE="Arial" ><I><IMG SRC="0cd66870.jpg" border=0 width="102" height="135" ALIGN="RIGHT" HSPACE="0" VSPACE="0"></I></FONT></div> <div> <I>Previously given birth and parenting</I></div> <div> <I>Not receiving public assistance</I></div> <div> <I>Healthy lifestyle</I></div> <div> <I>Problem free pregnancy and deliveries</I></div> <div> <I>No smoking or drugs</I></div> <div> <B>Please note, we are only working with Gestational Surrogates who reside in California and we are not working with Traditional Surrogates. Thank you!</B></div> <div>                           </div> <bR> </td> </tr></table></body>