Apply — Real Talk Surrogacy

About You

Takes about 3–5 minutes. Your info goes only to the agency — so they can skip their long intake and get you to a screening call faster. Real Talk's $1,000 bonus starts when you complete this application.

First Name

First name is required

Last Name

Last name is required

Email

Valid email is required

Phone

Phone number is required

We'll only share this with your chosen agency — never sold, never spammed.

Preferred Contact Method

State

State is required

Date of Birth — Month

Month is required

Day

Day is required

Year

Year is required

Pregnancy History

Approximate numbers are fine if you're not sure on exact counts.

Number of pregnancies

Required

Number of live births

Required

Vaginal deliveries

Required

C-section deliveries

Required

Miscarriages or stillbirths

Premature births (before 37 wks)

Any pregnancy complications? (select all that apply)

Pre-eclampsia

Gestational diabetes

Pregnancy-induced hypertension

Postpartum depression

Incompetent cervix

Other

None of the above

Please select at least one option

Health & Lifestyle

These answers help the agency and clinic keep you and the baby safe. Honest answers don't automatically disqualify you.

Height — Feet

Required

Inches

Required

Weight (lbs)

Required

Do you have health insurance?

Required

Do you currently smoke or use tobacco?

Required

Do you use marijuana or any recreational drugs?

Agencies need this for medical planning. Marijuana use in legal states is common and doesn't automatically disqualify you.

Briefly describe what and how often

Required

Are you currently taking any medications? (other than birth control)

List any medications you take regularly

Required

History of depression, anxiety, or other mental health conditions?

Brief description

Required

Home Life & Legal

A few questions about your situation — these help agencies understand your background.

Relationship Status

Relationship status is required

Do you have a support system who could help during a surrogate pregnancy?

Required

Have you or your partner been convicted of a felony?

Required

Do you or your partner have any pending legal cases?

Required

Do you currently receive government assistance?

Which types? (select all that apply)

SNAP / Food Stamps

Medicaid

Cash Assistance / Welfare

Section 8 / Public Housing

SSI / Disability

WIC

Other

Required

Some agencies can't work with certain programs because of state rules. Answering honestly helps us match you with agencies where you're most likely to be approved.

Your Preferences

These answers help match you with intended parents you feel good about.

Have you been a surrogate before?

Required

What's your timeline for becoming a surrogate?

Required

I'm open to working with: (select all that apply)

Same-sex couples

Single intended parents

International intended parents

Open to all

Required

Is there anything else you'd like the agency to know about you? (optional)

0/500

You're almost done — review and submit on the next screen to lock in your application and your Real Talk $1,000 bonus opportunity.

Review & Send to ...

Once you submit, the agency reviews your application and reaches out to schedule your screening call. Real Talk will track your journey so you're eligible for your $500 approval bonus and $500 match bonus.

You'll receive a $500 bonus when your agency approves you, plus another $500 when you match with intended parents — on top of your full agency compensation.

You must agree to share your application

Questions? Email us at [email protected]