Contact IPSA Referral Department

Do you need a referral to a surrogate partner or therapist? Do you need help determining whether Surrogate Partner Therapy is the right treatment option for you or your client?

Please complete the form below, let us know whether you are a therapist or a client, and where you are located. The IPSA Referrals Director will respond to you email in a day or so.

Your Name (required)

Your Email (required)

Your Phone (optional)

Your Location (City, State)

Subject

Your Gender...
 Male Female Other

Surrogate Gender Preference...
 Male Female Other

Your Message