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Application Form

Basic Information

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Date of Birth
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Your Age
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Your Height is: __ Feet
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And __ Inches
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Your weight in lbs
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Your BMI
The desired BMI range is 18-32. You need to work on your weight first before an IVF clinic could approve you.
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Religion Preference
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Ethnicity
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Pregnancy History

How many living births have you had in total ((including births through SURROGACY):
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Sorry, you are not qualifed to apply.

To be qualified as a surrogate, you need to at least have one living birth of your own. Besides you can not have more than 5 previous deliveries in total.
请列出每一胎生产的详细信息Please List Detailed Information for All Your Living Births.
Information of your 1st Child
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How was the baby delivered?
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Any other information we should know about this pregnancy?
Eg., Is it a surrogate baby? Any Health situations during Pregnancy? Complications for delivery...
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Information of your 2nd Child
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How was the baby delivered?
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Any other information we should know about this pregnancy?
Eg., Is it a surrogate baby? Any Health situations during Pregnancy? Complications for delivery...
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Information of your 3rd Child
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How was the baby delivered?
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Any other information we should know about this pregnancy?
Eg., Is it a surrogate baby? Any Health situations during Pregnancy? Complications for delivery...
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Information of your 4th Child
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How was the baby delivered?
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Any other information we should know about this pregnancy?
Eg., Is it a surrogate baby? Any Health situations during Pregnancy? Complications for delivery...
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Information of your 5th Child
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How was the baby delivered?
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Any other information we should know about this pregnancy?
Eg., Is it a surrogate baby? Any Health situations during Pregnancy? Complications for delivery...
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Information of your 6th Child
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How was the baby delivered?
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Any other information we should know about this pregnancy?
Eg., Is it a surrogate baby? Any Health situations during Pregnancy? Complications for delivery...
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Have you had any of the following: miscarriage, abortion, ectopic pregnancy, still birth, etc?
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