1. Journeys of the Heart Surrogacy Program Application

11% of survey complete.

Secure Application for Intended Parent(s)

Once you have completed this online form press 'send'. For a printable copy of the form please email info@journeysoftheheart.net

You can also write to us at:
Journeys of the Heart
PO Box 39
Hillsboro, Oregon 97123

Phone (503) 681-3075
Fax (503) 640-5834

All contents of this application are confidential and for internal use only by Journeys of the Heart. Please answer all questions. If a question doesn't apply to your family please enter 'n/a' where possible. If you are a single person, for yes/no choices indicate 'no' where spouse does not pertain.

Please send the following photographs with your application: Two (2) different, non-professional photos of the couple, or the single parent, close-up/full view of person(s), one of your home, exterior view. and one of children living at home.