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Placing baby for Adoption in Texas
  • I am pregnant
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Expectant Parent Intake (Short Form)

General Information

Your Race:(Required)
Are you a registered Native American Indian?(Required)
Is your housing situation stable?

Relationship Status

Relationship Status (Check all that apply):
Have you ever been legally divorced?
MM slash DD slash YYYY
Is your divorce within 300 days of the pregnancy?
Is he a possible father of the child?
Father #1 Race:
Is Father #1 a registered Native American Indian?(Required)
Is he aware of the pregnancy?
Are you still in contact with him?
Is he aware of the adoption plan?
Will he consent to the adoption?
Father #2 Race:
Is Father #2 a registered Native American Indian?(Required)
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?(Required)
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?(Required)
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?(Required)
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?

Medical

MM slash DD slash YYYY
Do you know gender?
Has Adoption Choices of Texas been provided proof of pregnancy?
Have you had any prenatal care?
Is your doctor aware of your adoption plan?
MM slash DD slash YYYY
MM slash DD slash YYYY
Do you have transportation to and from your appointments?
Do you have private insurance?
Do you have Medicaid?

Support

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

Choosing Adoption

Is your emergency contact aware of the adoption plan?
MM slash DD slash YYYY
Check box to acknowledge:(Required)

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Post-Adoption Communication Plans: Understanding Your Adoption Options

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  • Richmond
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Find Us

  • 5005 W. Royal Ln., Suite 291
    Irving, TX 75063
  • 2500 E T C Jester Blvd Ste 150 B
    Houston, TX 77088
  • Phone: 945-444-0333

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Our Offices

Serving Expectant Parents Statewide
Expectant Parent Hotline (24/7): 945-444-0333

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