Expense schedule.

Statement of charges incident to surrogate service. While all expenses incidental to a pregnancy vary from case to case, the following is a list of known expenses which should be considered only as a minimal estimate of the total expenses.

Medical expenses. [Natural Father's name], Natural Father, agrees to pay all unreimbursed medical expenses incident to the pregnancy of [Surrogate's name], Surrogate. Many Surrogates have medical insurance which includes maternity benefits. An insurance policy may be purchased for [Surrogate's name] if she does not have insurance coverage. Medical insurance generally covers almost all of the delivery expenses and a significant portion of the office visits involved. Unreimbursed medical expenses are billed monthly.

Transportation expenses. If it is necessary for [Surrogate's name], Surrogate, or _________, attorney for [Natural Father's name] to travel in regards to meeting the duties and obligations of this agreement, the cost will be billed monthly.

Paternity testing. A set of highly reliable blood tests are available to determine after the child's birth that [Natural Father's name] is the natural and biological father of the child. This test costs approximately $_____. If elected, this expense is payable after the child is born.

Surrogate fee. This fee is determined by [Surrogate's name], Surrogate, and [Natural Father's name], Natural Father, with _________, attorney for [Natural Father's name] acting as intermediary. The Surrogate fee is due prior to the first insemination. This fee is held in an escrow account. The fee is not paid to [Surrogate's name], Surrogate, until she delivers the child and surrenders custody to [Natural Father's name], Natural Father.

Psychiatric and psychological expenses. [Surrogate's name], Surrogate, must be evaluated by an independent psychiatrist. Two visits are recommended to achieve a more thorough evaluation. The average cost is approximately $_____. Psychological aptitude testing is optional, and costs an average of $_____.

Initial medical examination. [Surrogate's name], Surrogate, must be evaluated by a medical doctor. The cost is approximately $_____, but could be higher depending on the need for additional testing and further evaluation.

Insemination fee. Insemination costs are $_____, which includes insemination three times monthly for up to six months. This fee is in accordance with other fertility clinics that offer artificial insemination. Insemination must be done without regard to day of the week or holidays, and approximately 50% of the procedures usually involve weekend participation.

Surrogate attorney fee. It is very important for [Surrogate's name], Surrogate, to receive independent legal counseling relevant to the surrogate procedure so that she is aware of potential legal problems incident to the procedure. The typical attorney fee for this counseling is $_____.

Maternity clothes. This fee covers the cost of maternity clothes up to $_____.

Legal fees. This fee covers all legal agreement negotiations and representations for [Natural Father's name], Natural Father. The fee includes legal proceedings to amend the child's birth certificate to have his name entered as the natural and biological father if proceedings are instituted in _________.

Court costs, photocopying and postage.

A. Court Costs: due upon filing of a paternity case and run approximately $_____(This amount is not included in the legal fees.)

B. Photocopying and postage: approximately $_____.

Advertising fee. This fee covers a pro rata share of advertising costs for surrogates. Cost is approximately $_____.