Adoptive Family Consultation

Please complete the following consultation form to schedule a free, no obligation, OFFICE VISIT (no phone consultations provided) with our Founder & Executive Director Steffany Aye.

Steffany will provide you with an in depth face to face consultation that will cover the six different types of adoption. Our consultation will help streamline everything you have been reading, researching, learning from the internet and from others. It is our hope that you will find the office consultation beneficial and will provide you with the information needed to choose the avenue(s) of adoption that are right for your family.

Our consultation visits occur in our office with both husband and wife or same sex partners present, if single we encourage you to bring a support person with you. This office visit usually lasts less than an hour, depending on how many questions you have. There is no need to bring anything with you to this meeting and we look forward to meeting you soon!

NOTE: If you have ever completed any forms on our website (Information Request or Consultation Form), mark YES, you have submitted information to us before. This will save you time and prevent double entry of information. If you can't remember your password, that's OK, you can reset it.
 

Prospective Adoptive FATHER (If same sex family, either adopting parent can be Ap 1 or 2) Ap 1 LAST Name* * Ap 1 FIRST Name* * Ap 1 Preferred FIRST Name If different from Legal First Name Ap 1 DOB* * Ap 1 Gender* Female Male   Ap 1 Citizenship United States Australia Canada China Ethiopia France Germany Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine Show All Countries Ap 1 Occupation* * Ap 1 Work Phone ()-ext Enter Int'l Number Ap 1 Cell Phone ()-ext Enter Int'l Number Ap 1 Primary Email Ap 1 Secondary Email Ap 1 Preferred Contact Method Any Cell Work Home Primary E-Mail Address Secondary E-mail Address   Prospective Adoptive MOTHER (If same sex family, either adopting parent can be Ap 1 or 2) Ap 2 LAST Name* * Ap 2 FIRST Name* * Ap 2 Preferred FIRST Name If Different from Legal First Name Ap 2 DOB* * Ap 2 Gender* Female Male   Ap 2 Citizenship United States Australia Canada China Ethiopia France Germany Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine Show All Countries Ap 2 Occupation* * Ap 2 Work Phone ()-ext Enter Int'l Number Ap 2 Cell Phone ()-ext Enter Int'l Number Ap 2 Primary Email Ap 2 Secondary Email Ap 2 Preferred Contact Method Any Cell Work Home Primary E-Mail Address Secondary E-mail Address   Marriage Information- If applicable Marriage Date Family Address Street Address* Street Address Line 2 City* State/Region* AK - Alaska AL - Alabama AR - Arkansas AS - American Samoa AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida FM - Federated States of Micronesia GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MP - Northern Mariana Islands MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico PW - Palau RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VI - Virgin Islands VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming Enter Region Zip Code* Family Shipping Address Only enter Shipping Address if it is different from the Residence Address. Shipping Street Address Shipping Street Address Line 2 Shipping City Shipping State/Region AK - Alaska AL - Alabama AR - Arkansas AS - American Samoa AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida FM - Federated States of Micronesia GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MP - Northern Mariana Islands MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico PW - Palau RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VI - Virgin Islands VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming Enter Region Shipping Zip Code Contact Home Phone ()-ext Enter Int'l Number Familys Primary E-Mail Address* Familys Secondary E-Mail Address Opt Out of Agency E-Mailings Used only on a limited basis for important information Opt Out of Agency Mailings Mailings from us are extremely rare Password Please enter a password to use at a later time to access other forms on our website. Please write down and keep this password in a safe place. Family Login Password Password Already Set Change Password Confirm Password Password must be at least 8 characters with at least one uppercase letter, one lowercase letter, and one number. How did you learn about our agency? How did you hear about us?* Google Search Yahoo! Search Bing Search MSN Search Adoption.com International Placing Agency Friend Domestic Placing Agency Previous Client Facebook Acquaintance Attorney Mobile Web Adoptive Families Magazine Binti Referral Resolve Doctor Adoption Support Group/Conference Newspaper Counselor/Therapist Drive-By Building Sign Yellow Pages Church Radio Other   Referral Source Details Categories Interested In Please select the categories which you are interested in at this time Domestic Adoption International Adoption Embryo Adoption Foster Care Adoption Trans-Racial Adoption Home Study Services Other   If you selected Other, Please Specify What brings you to our office? Briefly explain what brings you to our office for a consultation and what you hope to learn during our time together:* If you have any Special Communication needs, then please explain: Consultation Time Preference Check all that apply. We will contact you via e-mail to set up an office appointment time. Day Time Appointment (T, W, Th 11 am - 3 pm) Evening Appointment (Monday @ 5, 6, 7 pm) Phone number for scheduling, if we are unable to reach you via e-mail ()-ext Enter Int'l Number We will most likely e-mail you for an appointment time Notes: Please indicate in Notes if you already have an appointment scheduled. Thanks! Additional Information Do you have a current adoption home study started or completed by another agency?* YesNo If yes, please explain Office Use Only Consultation Visit Date PC HS INTL DOM TRANS Initial Note:

Children: Gender and Age

How many children do you currently have? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

	Birth Date	Gender
		Female Male
		Female Male
		Female Male
		Female Male
		Female Male
		Female Male
		Female Male
		Female Male
		Female Male
		Female Male
		Female Male
		Female Male
		Female Male
		Female Male
		Female Male

Thank you! We will contact you shortly to schedule your consultation visit.

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