Expectant Parent Intake

General Information

Is your housing situation stable?
Is your emergency contact aware of your adoption plan? *
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Race *
Are you a registered Native American Indian? *

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Relationship Status

Check all that apply:
Have you ever been legally married? *
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Father

Father #1 Race
Is Father #1 a registered Native American Indian?
Are you still in contact with him? *
Is he aware of the pregnancy? *
Is he aware of the adoption plan? *
Will he consent to the adoption? *

Father #2 Race
Is Father #2 a registered Native American Indian?
Are you still in contact with him?
Is he aware of the pregnancy?
Is he aware of the adoption plan?
Will he consent to the adoption?

Father #3 Race
Is Father #3 a registered Native American Indian?
Are you still in contact with him?
Is he aware of the pregnancy?
Is he aware of the adoption plan?
Will he consent to the adoption?

Father #4 Race
Is Father #4 a registered Native American Indian?
Are you still in contact with him?
Is he aware of the pregnancy?
Is he aware of the adoption plan?
Will he consent to the adoption?

Father #5 Race
Is Father #5 a registered Native American Indian?
Are you still in contact with him?
Is he aware of the pregnancy?
Is he aware of the adoption plan?
Will he consent to the adoption?

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Medical

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Have you had any prenatal care? *
Has Texas Adoption Center been provided proof of pregnancy?
Is your doctor aware of your adoption plan?
Do you know gender? *
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Do you have transportation to and from your appointments?
Do you have insurance? *

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Support:

Is there anyone in your life who does not support your adoption plan? *

Choosing Adoption

Expectant Parent Signature *
clear
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