Our telephone hotline is open 24 hours-a-day, 7 days-a-week for you to speak directly with an A is 4 Adoption counselor. We are always here to help you with any questions or concerns. All information is kept strictly confidential.

*States required field

Name:*

Address: *

City: *

State: * Zip Code: *  

Phone: * Mobile:         

Email: *

What additional information may we provide for you? *

I / We would like to be contacted by an A is For Adoption Coordinator for a free, private consultation. *

To expedite the process, I would like to fill out the confidential questionnaire now, online. I understand there is no obligation to use A Is 4 Adoption services.

Prospective Adoptive Parent(s) Questionnaire

Please answer the following questions to the best of your ability.

Your Name(s)   

  1. What has led you to adoption?


    If you have experienced infertility, are your treatments concluded?
    Yes No
  2. What do you know about Adoption?
  3. What is your understanding of "Open Adoption"?
  4. What are your feelings about Adoption?
  5. Has anyone you know adopted or been adopted?
  6. What is your budget for your adoption?
    (To include: Advertising, Legal Fees, Home Study, Social Worker (ASP), Birthmother Living Expenses) (Check One):
    $25,000 - $30,000
    $30,000 - $35,000
    $35,000 - $40,000
    $40,000 Plus
  7. Are your adoption funds currently at your disposal or are you planning to finance your adoption and if so, how?
  8. What is your vision of a Birth Mother?
  9. Are you gender specific?
    Yes No
    If so, what gender?
    Girl Boy
  10. Do you have an ethnicity preference?
    Yes No
    If so, what preference?
  11. Are you married?
    Yes No
    If yes, how long:
  12. Are both of you equally desiring to adopt?
    Yes No
    If No or N/A, please explain:
  13. Do you currently have children?
    Yes No
    If yes,
    biological or adopted
    If yes, do they know about your plans to adopt?
    Yes No
  14. Have you ever been convicted of a crime other than a traffic violation?
    Yes No
    (If Yes, please explain)
  15. Have you ever been treated for depression or other psychological problems?
    Yes No
    If yes, please explain:
  16. Do you have any health conditions which restrict normal daily activities or reduce normal life expectancy?
    Yes No
    If yes, please explain:
  17. Are you open to a child that is already born?
    Yes No
    If yes, up to what year of age?
  18. What other Adoption Services have you considered or are you considering?