Confidential Parental Application



This is a secure form and 100% private. We will not use any of this information except to assist you in your selection of a surrogate, and none of the information you provide is ever disclosed to anyone.

Each applicant of a couple should fill out a separate form as not all questions apply to both partners.

The only requirements SMI has for its clients are that:

1) you are unable to have a child on your own without jeopardizing your or the fetus’ life (or there is no female partner in your life);

2) you are able to travel to/from the U.S. 3-4 times to participate in our program;

3) you want to give your love to a child

To complete the application process and reserve a meeting with Steven Litz, Director of SMI in Indianapolis, Indiana, you will be required to submit an application fee of $500 per couple.  At the end of this application, you will have the opportunity to waive the application fee entirely.


  1. You (and your spouse or partner, if applicable) fill out the application.
  2. After submitting it, you contact SMI at (317) 996-2000 to pay the $500 application fee.
  3. Mr. Litz will contact you to arrange for a meeting in Indianapolis for a complete introduction to surrogacy.  At that meeting you’ll be given a variety of paperwork, and you’ll have an opportunity to review profile sheets of the available surrogates.
  4. If you prefer, you have the option of waiving the application fee entirely and reviewing the profile sheets online, avoiding the time and expense of coming to Indianapolis.  If you are interested in this option, once you submit your application, please call SMI at (317) 996-2000 or send an email to to discuss this.

Step 1 of 5

  • Confidential Parental Intake Form

    Please fill out this form as accurately and truthfully as possible. Feel free to use extra space if necessary. Each applicant of a couple should fill out a separate form, as all questions may not apply to each partner.

  • I am
  • I am interested in selecting a surrogate for:
  • Address
  • Birth Date
  • To continue the application press the "Next" button below.

If you are unable to download the application, please give us a call at 1-888-SURROGATE, and we’ll be happy to mail one to you.