---
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: "2026-03-28T00:45:19.087Z"
---

[← 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)
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