In Phase One of the intake process the following forms will be emailed to you through DocuSign:
1) DocuSign for Delivery and medical records: We need to review records from all pregnancies and deliveries. It may take a little time to get your records, so that will be our very first step. Family Makers uses “Docusign” to enable you to easily complete and sign any required forms from the convenience of your phone, tablet or desktop. No printing required! You will receive a Docusign email with a Medical Records Release to complete, in addition to a form requesting that you list your previous and current Obstetricians, midwives, Reproductive Endocrinologists and delivering hospitals. We will begin requesting those records immediately.
2) DocuSign Detailed Medical History: While you provided some information to us on your application, we would like to gather additional details while waiting for your medical records. This form will be submitted along with your complete medical file to the clinic you will ultimately work with so please make sure to fill it out completely.
3) DocuSign Health Insurance Information: In addition to receiving general disclosures about the process, you will receive a DocuSign form requesting authorization to verify your pregnancy benefits as a surrogate. If we are unable to obtain verification or your insurance manual from your online portal, we can provide you with instructions on how to assist us in getting it.
4) DocuSign Agency Agreement: This agreement between yourself and Family Makers is to show your commitment to moving forward in the surrogacy screening and matching process.
5) Demographic, Insurance & Income Verification: As part of the screening process, we will need for you to provide us with a picture of your driver’s license, front & back of your insurance cards and the last three paystubs. During the intake process we will be completing background checks, insurance verification and income verification (also used for lost wages calculations). These documents can all be uploaded to us through the link below. If you are married, or in a committed relationship we will also need the driver’s license and last three paystubs for your partner.
Additional Phase One Intake Steps:
1) Clearance from your OB/Midwife: We require a signed letter on practice letterhead from your current OB/Midwife stating that he/she has no concerns if you become pregnant again, and that you have his/her support to be a surrogate. We will request this for you, along with your medical records.
2) Reliable birth control: Obviously if you are pursuing surrogacy, we do not want to be faced with an unexpected pregnancy. Please ensure that you are on reliable and consistent birth control. Natural family planning is not considered reliable. If you have had any negative side effects or issues with certain birth control pills, please let me know as well. If you are not currently on birth control pills, you may be asked to discuss starting them with your OB.
If you have an IUD, it will need to be removed and out for a minimum of 2 cycles (3 cycles for Mirena) before you can be matched as it can negatively affect uterine lining. If your cycles do not start after IUD removal, you should follow up with your OB for an evaluation. FMS recommends having IUD removed after medical records have been reviewed by our agency in order to avoid unnecessary removal if you are not approved.
3) Recent clear pap: Candidates who are ready to begin their journey must have a recent pap with negative/clear results, and should not have an IUD. If you haven’t gotten a pap in the last 12 months, one is required in order to move forward in the process.
***While annual visits with pap should be covered as a preventative care exam if you have insurance, IUD removal is not. Any costs associated with obtaining medical clearance from your OB, IUD removal, and any replacement birth control prescribed are your financial responsibility.***
Phase One Required Documents:
You will need to have your drivers license (and your spouse if applicable), three most recent paystubs (and spouse if applicable), family photos, and insurance information (cards and policy book) available to complete the form below. Any questions, just give us a holler!
Once we have received an update on these items, we will proceed to the next steps of our intake and screening process, including a video call together. Your Case Manager will remain in contact with you each step of the way and keep you updated each step of the way. If you ever have any questions, you can text, call or email your Case Manager anytime. We want you to know that we are here for you and a part of this journey with you!