Lawrence A. Kalikow, Attorney at Law
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Gestational Carrier & Surrogate Questionnaire
If you are interested in being a gestational carrier or traditional surrogate, are in good health, are over twenty-one years of age, live in Pennsylvania or a nearby state (other than New York) and have previously given birth to at least one child, please send Mr. Kalikow an e-mail at LAKalikow@aol.com or call him at 215-682-9100.

Mr. Kalikow represents intended parents who are waiting to find the right person to carry their child. To expedite things, you may wish to complete and send the preliminary questionnaire below.

No attorney/client relationship is established by filling out this questionnaire.
 
Name
Phone
Email
Address
City
State
Zip Code
Age
Marital Status
How many biological children do you have?
When did you last give birth to a child?
Do you smoke or use tobacco?
Do you have health insurance that includes coverage for prenatal care and delivery?
Are you employed and, if so, how?

 
Are you interested in being a:
Comments
 
Thank you for completing this questionnaire. Your interest in being a gestational carrier and/or traditional surrogate is sincerely appreciated.




Lawrence A. Kalikow, Attorney at Law
Warminster Corporate Center
65 W. Street Road, Suite A203
Warminster, PA 18974
Tel: (215) 682-9100
E-mail: LAKalikow@aol.com

LEGAL DISCLAIMER: The information provided on this Web site is advertising material and is for informational purposes only. The material on this site does not constitute legal advice. DO NOT use this information without first consulting an attorney. No Attorney-Client relationship is formed unless agreed to in writing.
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