Pregnant and Considering Adoption Mentor Request Form

Are you pregnant and considering making an adoption plan? Do you think it would be helpful to talk with someone who has been through it all before? If so, please fill out the brief form below. We will soon match you with a mentor, another member of BirthMom Buds who has already placed a child for adoption and has volunteered her time to help ease your journey. She will be there to listen as you consider this choice.

NOTE:
As of 11/07 our form is currently not working so please copy/paste the below information
in an email to BirthMom Buds so that we can get you paired with a mentor right away!
We apologize for the inconvenience and appreciate your understanding!

Name :

Age :

Your birthdate:

Your due date: year

State you currently live in:

Mailing address: (This is optional of course, but we like to send out a care package around time of the baby's birth or placement.)

Address:
City: State Zip Code

Email address: (PLEASE DO NOT FORGET TO PUT YOUR EMAIL ADDRESS!!! WITHOUT IT, WE CAN NOT GET IN TOUCH WITH YOU AND YOUR MENTOR CAN NOT GET IN TOUCH WITH YOU EITHER!!)

Choose the following statement that bests describes you at the moment.

I am pregnant and considering adoption and would like to speak with a birthmom to know more about it.

I have already made an adoption plan and am following through with it.

I know nothing about adoption and need more information.

Have you chosen to go through an agency, attorney, facilitator, or other? (If you do not know yet, its fine to say that!)

Have you chosen a family yet?

What type of adoption are you leaning toward?

Any other comments or information you would like to tell us?? (is the birthfather involved, do you have other children, etc)

Where did you hear about BirthMom Buds?