(a) Surrogacy programs shall obtain written informed consent from all prospective parties to the surrogacy agreement prior to entering into such agreement and shall develop and implement an informed consent form. The informed consent form shall be written in plain language and available in English, or the language the individual giving consent is most proficient in reading, and shall include, at a minimum, the following:

1. (1) a statement that the surrogate has been informed that their name and address will be kept on file by the surrogacy program;
2. (2) a statement that the surrogate has been advised of the option to voluntarily share their information with the surrogacy registry upon completion of the surrogacy agreement;
3. (3) HIPAA-compliant authorization for disclosure of the surrogate’s relevant medical history information to prospective intended parent(s) and their physicians, consistent with statutory requirements for the disclosure of medical information;
4. (4) a statement that the surrogate has the right to terminate the surrogacy agreement prior to becoming pregnant by means of assisted reproduction pursuant to article 5 C of the Family Court Act;
5. (5) a statement regarding the surrogacy program’s screening of prospective surrogates, and the criteria assessed therein; and
6. (6) a copy of the Surrogates’ Bill of Rights, as set forth in article 5 C of the Family Court Act.