--- title: Surrogate Mother Screening Intake Form Template | Paperform description: Professional surrogate mother screening form for agencies and clinics. Collect medical history, pregnancy experience, lifestyle assessment, psychological evaluation, and support system information. url: "https://paperform.co/templates/surrogate-mother-screening-intake-form" type: static generatedAt: "2026-04-04T00:45:22.657Z" --- [← Back to free form templates](/templates/) ![Surrogate Mother Screening Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/surrogate-mother-screening-intake-form.png) [Preview](https://_preview.paperform.co/ai-template/surrogate-mother-screening-intake-form) [Use this template for free](/create?ai-template=surrogate-mother-screening-intake-form) [Intake Forms](/templates/category/intake-forms/)[Healthcare & Medical Forms](/templates/category/healthcare/)[Legal & Compliance Forms](/templates/category/legal/) [Healthcare](/templates/industry/healthcare/) [Counselor](/templates/role/counselor/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Lawyer](/templates/role/lawyer/) About this free form template Finding the right surrogate mother is one of the most important steps in the surrogacy journey. This **Surrogate Mother Screening Intake Form** helps surrogacy agencies, fertility clinics, and reproductive health professionals conduct thorough initial assessments of prospective surrogates—gathering critical information about medical history, pregnancy experience, lifestyle factors, psychological readiness, and support systems in one organized, professional form. Built with Paperform, this template goes beyond basic data collection. **Conditional logic** reveals follow-up questions based on responses, ensuring you only ask relevant questions while maintaining a smooth experience for applicants. The form's **age verification** and qualification screening help you identify suitable candidates early in the process, saving time for both your team and applicants. Whether you're a surrogacy agency, fertility clinic, reproductive endocrinologist, or matching coordinator, this form streamlines your intake workflow while maintaining the sensitivity and professionalism this process demands. You can customize questions to match your specific screening criteria, add your branding, and even connect responses to your CRM or case management system. After submission, use [Papersign](https://papersign.com) to send consent forms and legal agreements for eSignature, keeping everything connected to the original intake. You can also set up [Stepper](https://stepper.io) workflows to automatically route qualified candidates to your medical team, schedule initial consultations, or trigger background check processes—turning each submission into a coordinated multi-step screening journey. This template is trusted by surrogacy professionals who need compliant, compassionate intake forms that respect the significance of this life-changing decision while gathering the comprehensive information needed to ensure the best outcomes for all parties involved. Built for growing businesses, trusted by bigger ones. Trusted by 500K+ business owners and creators, and hundreds of millions of respondents. ![Capterra - 4.8 out of 5](/images/capterra-st.jpg) ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg) ![G2 - 4.8 out of 5](/images/g2-st.jpg) [Try Paperform free now](/register) ## More templates like this [![Missing Client Report - Torture Treatment Center](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/missing-client-report-torture-treatment-center.png) ### Missing Client Report - Torture Treatment Center A compassionate and secure form for torture treatment centers to report missing asylum seeker clients, document their persecution history, legal case details, and coordinate urgent notifications with trauma therapists and immigration attorneys.](/templates/missing-client-report-torture-treatment-center/) [![Corrections Mental Health Diversion Program Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/corrections-mental-health-diversion-program-referral-form.png) ### Corrections Mental Health Diversion Program Referral Form Refer individuals with mental illness from the criminal justice system to community-based treatment programs as an alternative to incarceration.](/templates/corrections-mental-health-diversion-program-referral-form/) [![Mental Health Diversion Completion Certificate](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/mental-health-diversion-completion-certificate.png) ### Mental Health Diversion Completion Certificate A comprehensive certificate form documenting treatment progress, symptom management, and clinical recommendations for mental health diversion program completion in court proceedings.](/templates/mental-health-diversion-completion-certificate/) [![Surrogate Mother Application Identity Verification Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/surrogate-mother-application-identity-verification-form.png) ### Surrogate Mother Application Identity Verification Form A comprehensive identity verification and application form for prospective surrogate mothers, including medical history, psychological evaluation consent, background checks, and pregnancy documentation.](/templates/surrogate-mother-application-identity-verification-form/) [![ACC Severe Injury Rehabilitation Plan](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/acc-severe-injury-rehabilitation-plan.png) ### ACC Severe Injury Rehabilitation Plan A comprehensive rehabilitation planning form for ACC severe injury cases, coordinating multi-disciplinary care teams, tracking long-term recovery goals, and monitoring milestone achievements throughout the rehabilitation journey.](/templates/acc-severe-injury-rehabilitation-plan/) [![Addiction Recovery Program Discovery Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/addiction-recovery-program-discovery-form.png) ### Addiction Recovery Program Discovery Form A comprehensive intake form for addiction recovery programs to assess client needs, substance use history, treatment preferences, and recovery goals for personalized care planning.](/templates/addiction-recovery-program-discovery-form/) [![Animal-Assisted Therapy Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/animal-assisted-therapy-intake-form.png) ### Animal-Assisted Therapy Intake Form A comprehensive intake form for animal-assisted therapy programs that screens for allergies, assesses comfort with animals, and establishes therapeutic goals for clients seeking healing through animal interaction.](/templates/animal-assisted-therapy-intake-form/) [![Child Advocacy Center Missing Child Victim Witness Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/child-advocacy-center-missing-child-victim-witness-report.png) ### Child Advocacy Center Missing Child Victim Witness Report A comprehensive intake form for child advocacy centers to document missing child cases, schedule forensic interviews, track protective custody status, and coordinate with law enforcement and court proceedings.](/templates/child-advocacy-center-missing-child-victim-witness-report/) [![Child Custody Evaluator Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/child-custody-evaluator-intake-form.png) ### Child Custody Evaluator Intake Form Comprehensive intake form for child custody evaluation services. 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