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Request an Information Packet

IAC understands that an unplanned pregnancy raises many issues and many questions.

Our counselors are prepared to provide you with the support and information that you need as you determine which option is best for you. They are caring, knowledgeable, and experienced - and want to hear from you. When you are ready, they are prepared to listen and help you begin developing a plan. With the Independent Adoption Center:

  • All birthmother and birthfather services are free
  • You will choose the family for your baby

When you're ready to talk with someone just give us a call on our toll free number at 1-800-877-OPEN (6736).

If you would like a free information packet, just complete the form below. All materials will be mailed in a confidential envelope.

*Required fields are denoted with a red asterisk.

ABOUT ME:

Name(s) (If you are a couple, please include both names)

*First:    *Last:

Phone: ( ) -

 First:     Last:

Phone: ( ) -

*E-mail:

Street Address 1:

Street Address 2:

*City: *State: Zip:

Estimated due date:

ADDITIONAL INFORMATION:

How did you hear about us?*

Please type in the field below the Name of the Search Engine (Google, etc.) or Friend or Counselor, etc. that lead you to us.

Please Name:

If you found us through a Search Engine, please type in the search word or words you used to find us (or you can add any additional text you feel would be helpful to us):

Search Word(s):


COMMENTS:

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