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"As an adoption counselor for over 25 years, I know this will be the most important decision you will ever make, but I promise you honest answers and confidential individual counseling. You will understand your rights and the adoption process before you make any decisions. All correspondence and contacts are strictly confidential."

GOD BLESS YOU, Charlotte Duncan and Staff
 
Birth Family Intake: 1-800-392-5969
Adoptive Family Intake: 1-713-529-5125		 Please complete and submit the following form.
* denotes required fields.
   
* First Name:
* Last Name:
Address:
City:
State:
Zip:
   
* Phone:
* E-mail:
Age:
   
Pregnant?* Yes No Approximately how far along? 
Medicaid Insurance? Yes No
Pre-existing Medical Condition? Yes No
Has your baby been born? Yes No
Married? Yes No
 
Race of Mother:
Anglo African/American Hispanic
Asian Other:
 
Race of Father:
Anglo African/American Hispanic
Asian Other:
 
How did you hear about us?
Yellow Pages Search Engine
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Doctor Other (please specify):
 
Comments:
 
After the contact form has been filled out and submitted, I look forward to responding to your e-mail personally and encourage you to contact me direct in Houston at 713-529-5125 or 1-800-392-5969.
A Licensed Texas Adoption Agency
 
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